Smoking Cessation Treatment Program Research Articles

Approaches and Strategies for Habit Intervention in Smokeless Tobacco/Arecanut/ Betel Quid and Non-Starting

Background: Although adequate research has been conducted regarding smoking and smokeless tobacco, there is a dearth of research exploring reasons for chewing areca nut and betel-quid. Global epidemiology of areca nut and betel-quid shows distinct ethnic and cultural preferences. Areca nut is chewed for its psychological stimulating effects and perhaps, a medicinal value. To develop empirically supported treatments and to promote nonstarting, healthcare workers and researchers must first understand the reasons people engage in the behavior. Aim: To discuss evidence based approaches and strategies for habit intervention in smokeless tobacco/arecanut/betel-quid and nonstarting. Methods: Data were collected from published national and international research, conference reports, WHO reports, tobacco control guides, Clinical Best Practice Guidelines and Cochrane database systematic reviews. Results: Individual behaviors are largely determined by complex range of factors beyond the control of the most individuals. Behavior change is complex and most people are well-informed about the basic health messages. Most people will have extensive experience of attempting to change their health career including quitting tobacco products. It is therefore essential to know a detailed history of a person's previous experiences of change and learn from this. Interventions need to match individuals' desire and ability to change. Encouragement, understanding, support, and empathy are all essential to enable clients achieve their goals. The most effective preventive intervention that a clinician can provide for tobacco-using patients against is an empathic, personalized smoking cessation intervention program with extended assistance and follow-up. The goal of the intervention must be complete cessation. Reduction provides no direct health benefits to the individual. Oral examination by a dental professional who points out tissue damage from smokeless tobacco use in a user´s own mouth, advice to quit, and brief problem solving and supportive counseling are effective in promoting smokeless tobacco cessation. There is also a need to develop culturally tailored areca nut and betel-quid cessation and risk reduction programs, the first step in reducing the public health burden associated with betel-quid chewing worldwide. Interventions are available, but underutilized, in part due to lack of clinician training and organizational support. Conclusion: Although the deleterious effects of smokeless tobacco/areca nut/betel-quid are well known by both users and healthcare workers, the knowledge has not translated effectively into cessation. Proven, brief, repetitive, directed interventions tailored to the needs of the patients can increase successful cessation. Controlling sociodemographic, environmental and personal factors may promote nonstarting.

Cross-sectional study associating secondhand smoke exposure and development of tuberculosis in children (Effect of a Smoking Cessation Intervention Program for Families on the Clinical Outcome of Children Diagnosed with TB)

Cross-sectional study associating secondhand smoke exposure and development of tuberculosis in children (Effect of a Smoking Cessation Intervention Program for Families on the Clinical Outcome of Children Diagnosed with TB)

Cross-sectional study associating secondhand smoke exposure and development of tuberculosis in children (Effect of a Smoking Cessation Intervention Program for Families on the Clinical Outcome of Children Diagnosed with TB)

With a strong body of evidence linking active smoking to tuberculosis (TB), the research team seeks to further investigate the potential link between exposure to secondhand smoke (SHS) and development of pediatric TB. The current baseline study falls under the research “Effect of a Smoking Cessation Intervention Program for Families on the Clinical Outcome of Children Diagnosed with TB”. The research is conducted in two peri-urban areas and implemented within the existing National TB Program. Funding for the research originates from USAID through the US …

Smoking Cessation Treatment Programs Offered at Hospitals Providing Oncology Services.

Many people with cancer continue smoking despite evidence that it negatively effects cancer treatment, worsens chemotherapy toxicity, and increases risk for a second cancer. We examined tobacco treatment services offered to cancer patients at hospitals providing oncology services, including National Cancer Institute (NCI)-Designated Cancer Centers (NDCCs). We examined survey data of 6,400 U.S. hospitals from 2008 to 2015 to determine the manner in which tobacco treatment/cessation program services were provided among NDCCs and non-NDCC hospitals providing oncology services (HPOs). From 2008 to 2015, 784 responses from NDCCs and 18,281 responses from HPOs were received. NDCCs (86%) reported significantly higher tobacco treatment/cessation programs owned by the hospital compared to HPOs (68%) (p < 0.001). Among NDCCs, there was a significant increasing trend of tobacco treatment/cessation programs reported owned by the hospital, the health system, or other contractual mechanism from 2008 to 2015 (p = 0.03). More than 80% of oncology providing hospitals report providing tobacco cessation programs, with higher percentages reported in NDCCs. As hospitals implement smoking cessation programs, partnerships between hospitals and cancer coalitions could help bring tobacco cessation activities to communities they both serve, and link discharged patients to these cessation resources so they can continue quit attempts that they initialised while hospitalised.

The impact of social media-based support groups on smoking relapse prevention in Saudi Arabia

Background and objectiveTobacco smoking remains a major preventable cause of mortality and morbidity across the globe. People who attempt to quit smoking often experience episodes of relapse before finally quitting. Understanding the part that social networking sites and social media can play in smoking cessation and prevention of relapse is important to aid the development of novel techniques to curb the smoking epidemic. This study investigated the use of extra-treatment provided outside of the formal healthcare setting, bolstered by online social support in order to prevent smoking relapse in Saudi Arabia. MethodsThis cross-sectional study included 473 smokers taking part in smoking cessation intervention programs run by the Riyadh branch of King Abdul-Aziz Medical City and PURITY, a Saudi anti-smoking association. Only subjects who expressed an interest in quitting smoking, and those attempting to quit, were considered for inclusion. The sample was divided into three groups: subjects who subscribed to support groups on Twitter (n = 150), and WhatsApp (n = 150), and a control group of subjects who had not subscribed to any social media support groups (n = 173). ResultsA significant difference was found between the mean average numbers of people who quit smoking among the three groups, with social media support proving to be more effective than other traditional methods. Our findings imply that Twitter and WhatsApp users found it easier to quit smoking than those who did not take part in these social media groups. ConclusionSocial media provides a good platform to discuss smoking cessation treatment, and thus reduce smoking relapses. Our findings support the suggestion that more social media support groups should be developed to help people to effectively cease smoking after abstinence. Individuals who struggle to quit smoking should be encouraged to join support groups on their social media platform of choice to increase their likelihood of quitting. Future studies should assess the effectiveness of social media to help people quit smoking by including a greater diversity of social media platforms, including Facebook, Snapchat, and Instagram.

Smoking cessation intervention programme in four secondary boys' schools in Malaysia

Smoking cessation intervention programme in four secondary boys' schools in Malaysia

Effect of Transtheoretical Model Based Intervention Program on Cigarette Smoking Cessation among Technical Secondary School Male Students in Zagazig City

Background: Interventions via cognitive-behavioral strategies are promising in smoking cessation among adolescents, by using the Transtheoretical model (TTM). Objective: To assess the effect of TTM- intervention program on smoking health risk, stages and process of change in smoking cessation, , decisional balance, and self-efficacyamong technical secondary school male students in Zagazig city. Methods: A quasi-experimental study conducted in two randomly selected technical secondary schools in Zagazig city, Sharkia Governorate, Egypt. Male smokers from one school assigned as an experimental group and those from the other school as a control group. The experimental group received interventions based on the stage of behavior change through group counseling followed by individual phone counseling for 10 months. Intervention evaluation was done through self-reported questionnaires assessing knowledge and TTM outcomes. Results: After the intervention, participants in the experimental group (32%) progressed from lower to higher stages of behavior change compared with those in the control group (1.9%). The participants who reached the action/maintenance stage were 13.9% in the experimental group versus 1.9% in the control group. There was a significant difference between two groups in the mean scores of knowledge, processes of change, decisional balance and self-efficacy (P < 0.000). Conclusion: The TTM-based smoking cessation intervention program was effective in inducing a positive movement in the stages of behavior change among adolescent smokers through improving knowledge, experiential and behavioral processes, decisional balance and self-efficacy.

A Randomized Trial of Text Messaging for Smoking Cessation in Pregnant Women

There is a need for innovation in both the enrollment of pregnant smokers in smoking cessation treatment programs and in the types of treatments offered. The study tests whether an interactive and intensive text messaging program, Quit4baby, can promote smoking cessation for pregnant women already enrolled in a health text messaging program, Text4baby. Between July 2015 and February 2016, a total of 35,957 recruitment text messages were sent to Text4baby subscribers. Eligible pregnant smokers were enrolled and randomized to receive Text4baby (control) or Text4baby and Quit4baby (intervention; N=497). Participants were surveyed at 1 month, 3 months, and 6 months post-enrollment, and saliva samples were collected at 3 months for biochemical verification of smoking status. Data were collected from 2015 to 2016 and analyzed in 2016. Using an intention-to-treat analysis, 28.80% of the intervention group and 15.79% of the control group reported not smoking in the past 7 days at 1 month (p<0.01), and 35.20% of the intervention group and 22.67% of the control group reported not smoking in the past 7 days at 3 months (p<0.01). Biochemical verification of smoking status at 3 months indicated no significant differences between groups (15.60% in the intervention group and 10.93% in the control group [p=0.13]), although significant differences favoring the intervention were found for older smokers (p<0.05) and for those who enrolled in their second or third trimester of pregnancy (p<0.05). Self-report of late pregnancy 7- and 30-day point prevalence abstinence favored the intervention group (p<0.001, p<0.01). No significant differences were observed at the 6-month follow-up or in the postpartum period. Results provide limited support of the efficacy of the Quit4baby text messaging program in the short term and late in pregnancy, but not in the postpartum period.

Cigarette Smoking Attenuates Kidney Protection by Angiotensin-Converting Enzyme Inhibition in Nondiabetic Chronic Kidney Disease

Background: Cigarette smoking exacerbates the estimated glomerular filtration rate (eGFR) decline in nondiabetic chronic kidney disease (CKD) despite the kidney protection that is achieved by angiotensin converting enzyme inhibition (ACEI). Whether smoking cessation restores ACEI-related kidney protection is not known. Methods: This 5-year, prospective, prevention trial recruited 108 smokers and 108 nonsmokers with stage-2 nondiabetic CKD with primary hypertension and urine albumin-to-creatinine ratio (Ualb) >200 mg/g. All smokers underwent smoking cessation intervention programs. Blood pressure was reduced in all participants toward achieving a goal of <130 mm Hg with regimens including ACEI. The primary outcome was eGFR change, and secondary outcomes included Ualb and urine levels of angiotensinogen (UATG), a surrogate for kidney angiotensin II (AII) levels, and isoprostane 8-isoprostaglandin Fgt;2a (U8-iso), an indicator of oxidative stress. Results: One-year Ualb was lower than baseline in nonsmokers but not in either smoking group, supporting greater ACEI-related kidney protection in nonsmokers than smokers. Higher Ualb at 1 year in continued smokers was associated with higher UATG and higher U8-iso, consistent with smoking-induced AII and increased oxidative stress contributing to less ACEI-related kidney protection in smokers. Baseline eGFR was not different among groups (p = 0.92), but 5-year eGFR was higher in quitters than in continued smokers (62.0 ± 5.4 vs. 52.9 ± 5.6 mL/min/1.73 m>2, p < 0.001); this value was lower in quitters than in nonsmokers (64.7 ± 5.6 mL/min/1.73 m>2, p = 0.02). Conclusions: Smoking cessation compared with continued smoking ameliorates eGFR decline in nondiabetic CKD treated with ACEI, possibly by restoring kidney-protective effects of ACEI through reductions in kidney AII and oxidative stress.

Neural correlates of tobacco cue reactivity predict duration to lapse and continuous abstinence in smoking cessation treatment.

It has been hypothesized that neural reactivity to drug cues in certain limbic/paralimbic regions of the brain is an indicator of addiction severity and a marker for likelihood of success in treatment. To address this question, in the current study, 32 participants (44 percent female) completed a functional magnetic resonance imaging cigarette cue exposure paradigm 2hours after smoking, and then enrolled in a 9-week smoking cessation treatment program. Neural activation to smoking cues was measured in five a priori defined limbic/paralimbic regions previously implicated with cue reactivity across substances. These included regions of the ventral striatum, anterior cingulate cortex and amygdala. Cox proportional hazard modeling was conducted to predict the number of days to first smoking lapse by using neural activation in these regions. Greater neural activation during pre-treatment exposure to smoking cues in the right ventral striatum, the left amygdala, and the anterior cingulate was associated with longer periods of abstinence following cessation. A similar pattern was present for continuous abstinence for the full duration of treatment. While baseline levels of nicotine dependence were strongly associated with treatment outcome, activation in the right ventral striatum predicted duration of abstinence beyond level of nicotine dependence. These results suggest that pre-treatment reactivity to smoking cues in areas associated with cue reactivity may be associated with successfully maintaining abstinence during treatment. This is consistent with models that propose that as addiction becomes more severe, motivational processing shifts from regions that subserve reward salience and learning to regions responsible motor behavior and habit learning.

The Effect of an Inpatient Smoking Cessation Treatment Program on Hospital Readmissions and Length of Stay.

The objective of this study is to estimate the impact of an inpatient tobacco cessation treatment program on 30-day readmission rates and length of stay (LOS). Participants were 28,994 patients admitted to the hospital between July 2012 and July 2014. Smokers were identified through the electronic medical records system and were offered cessation treatment. Program effects were estimated by using a difference-in-differences approach, comparing all smokers to all nonsmokers before versus after introduction of the program. Readmission rates were modeled by using probit regression; LOS was modeled by using truncated negative binomial regression. Models controlled for age, sex, race, payer, hospital department, severity of illness, and intensive care unit days. The hospital-initiated smoking cessation intervention had no significant effect on 30-day readmission rates or LOS. Other control variables had the expected signs and were statistically significant. The evaluation of an inpatient tobacco dependence treatment did not find significant short-term changes in healthcare utilization in the first 30 days after initial hospitalization.

Respiratory problems and anxiety sensitivity in smoking lapse among treatment seeking smokers

PurposeThe current study examined whether the interaction of lower respiratory symptoms and anxiety sensitivity is related to smoking lapse in the context of smoking cessation. MethodParticipants were adult daily smokers (N=60) exposed to the World Trade Center (WTC) disaster who were in a smoking cessation treatment program (75.0% male, 50.6years old [SD=9.2], and current smoking rate was 17.6 cigarettes per day (SD=10.6). ResultsResults indicated that the interaction between lower respiratory symptoms and anxiety sensitivity was a significant predictor of greater risk for lapse (i.e., lower survival time; B=0.005, OR=1.01, p=0.039). Follow-up analysis showed that greater respiratory symptoms were a significant predictor of lapse risk among those with high (B=0.116, OR=1.12, p=0.025), but not those with low (B=−0.048, OR=0.95, p=0.322), levels of anxiety sensitivity. DiscussionThe findings from the current study suggest that smokers with greater respiratory symptoms and higher levels of anxiety sensitivity may be associated with early lapse to smoking following smoking cessation treatment. Future work has the potential to inform the development of tailored cessation interventions for smokers who experience varying levels of lower respiratory symptoms and anxiety sensitivity.

Two-Year Effects of a Classroom-Based Smoking Prevention and Cessation Intervention Program

Background: Project EX is a classroom-based smoking prevention and cessation intervention program that has been well evaluated and designed for assessing the prevention and cessation effects among adolescents in Spain. However, its long-term efficacy is still unknown. This study deals with the outcomes of a 2-year follow-up evaluation of Project EX. Methods: The intervention was tested using a clustered randomized controlled trial involving 1,546 Spanish students from 3 program schools and 3 control schools. At the end of the 2-year follow-up period, 722 subjects had completed the questionnaires (266 in the control condition and 456 in the program condition) administered to them. Results: Compared to the control condition, the program condition revealed a greater reduction in nicotine dependence (p = 0.04), smoking intention (p = 0.02), and in the number of cigarettes smoked during the previous month (p = 0.03). The CO monitor repeated assessments revealed a significant decrease of ppm levels in the program group (p < 0.001). Intent-to-treat quit rates were 14.28 and 0%, respectively, for the program and control conditions. Conclusions: This study provides evidence about the long-term effectiveness of the Project EX classroom-based program for smoking prevention and cessation among adolescents in Spain.

The Use of Self-Directed Relapse Prevention Booklets to Assist in Maintaining Abstinence After a 6-Week Group Smoking Cessation Treatment Program: A Randomized Controlled Trial.

Identifying effective relapse prevention interventions is a vital step to help smokers maintain abstinence for the long term. The purpose of this study is to determine if providing recently quit smokers with self-directed relapse prevention booklets is effective at maintaining abstinence after intensive group smoking cessation treatment. Two hundred and twenty-five participants were randomized to receive Forever Free (FF) relapse prevention booklets or a control booklet (Surgeon General's report, SG) at the end of a 6-week group treatment program. Participants were then contacted by phone to assess whether they had read the materials. Smoking status was assessed 6 months after their target quit date. Primary analyses focused on the 115 participants who quit at the end of treatment. There was no difference in the 6-month quit rate between groups (40.7% quit FF vs. 44.6% quit SG, p = .67). The FF group read a significantly smaller proportion of the materials versus the control booklet (20.0% read most or all of FF vs. 72.0% of SG, p < .001). Forever Free self-directed relapse prevention booklets did not reduce relapse or enhance cessation over general tobacco and health information when added to intensive group smoking cessation treatment. However, this study lacked power to detect a small but clinically meaningful positive effect.

Neural correlates of graphic cigarette warning labels predict smoking cessation relapse

Exposure to graphic warning labels (GWLs) on cigarette packaging has been found to produce heightened activity in brain regions central to emotional processing and higher-order cognitive processes. The current study extends this literature by using functional magnetic resonance imaging (fMRI) to investigate neural activation in response to GWLs and use it to predict relapse in an evidence-based smoking cessation treatment program. Participants were 48 treatment-seeking nicotine-dependent smokers who completed an fMRI paradigm in which they were exposed to GWLs, text-only warning labels (TOLs), and matched control stimuli. Subsequently, they enrolled in smoking cessation treatment and their smoking behavior was monitored. Activation in bilateral amygdala, right dorsolateral prefrontal cortex, right inferior frontal gyrus, left medial temporal gyrus, bilateral occipital lobe, and bilateral fusiform gyrus was greater during GWLs than TOLs. Neural response in the ventromedial prefrontal cortex (vmPFC) during exposure to GWLs (relative to a visual control image) predicted relapse during treatment beyond baseline demographic and dependence severity, but response in the amygdala to GWLs did not. These findings suggest that neurocognitive processes in the vmPFC may be critical to understanding how GWL's induce behavior change and may be useful as a predictor of smoking cessation treatment prognosis.

Weight Concerns Associated With Delay in Quit Date But Not Treatment Outcomes: A Czech Republic Experience.

Weight concerns are prevalent in smokers and may reduce the success rate of quitting. This concept has been primarily studied on US populations and it is unknown how weight concerns may differ cross-culturally. This study examined the role of weight concern in European smokers wishing to stop smoking. A sample of 593 smokers (299 men and 294 women, mean age 38 years) utilizing the Centre for Tobacco-Dependent in Prague, Czech Republic, between 2010 and 2013 were studied. Weight concerns were assessed at baseline prior to treatment by evidence-based stop smoking methods. Abstinence was evaluated at 12 months post baseline. Approximately 34% of all patients (204/593) were classified as weight concerned (by indicating on the Weight Concern Scale that they would return to smoking after any weight gain) at the time they sought treatment. Among all men, 19.4% (58/299) were weight concerned and among all women, 49.7% (146/294) were weight concerned. Among females, weight-concerned smokers were of similar weight, but younger (p < .001), and had been smoking cigarettes for fewer years (p = .002) compared with those without weight concerns, whereas the male weight-concerned smokers were significantly (p = .030) heavier than those without weight concerns. Although the presence of weight concern was associated with a delay in setting a quit date (log-rank test p = .019), it was not associated with abstinence at one year. The quit success rate of weight-concerned smokers in Czech Republic did not differ from those without weight concern when utilizing an individualized smoking cessation treatment program. Individually tailored tobacco dependence treatment could help to prevent weight concern from affecting successful quitting. This study adds the new cross-cultural aspect of post-cessation weight concern. Weight concern has been studied primarily on US populations and our sample consists of European sample of smokers. Additionally, we have found that the presence of weight concern lead to delay in setting a quit date, but the success rate of those weight concerned did not differ from those without weight concern. Thus, it is possible, that this individualized evidence-based tobacco treatment program was able to prevent weight concern impact towards successful quitting.

Distress intolerance during smoking cessation treatment

Distress intolerance is a key vulnerability factor implicated in the maintenance and relapse of cigarette smoking. Yet, past work has not examined changes in these processes during smoking cessation treatment or their relation to smoking cessation outcomes. The aim of the present study was to examine the effect of two smoking cessation interventions on changes in self-report and behavioral distress intolerance indices during treatment, and whether these changes are associated with smoking cessation outcomes. Treatment-seeking smokers (N = 384) were randomly assigned to one of two 4-session smoking cessation treatment programs: Standard Cessation Program (SCP) or Smoking Treatment and Anxiety Management Program (STAMP). Quit dates were scheduled to coincide with the final treatment session. Physical domains of distress intolerance were assessed at baseline and at each weekly session, via the Discomfort Intolerance Scale (DIS; higher scores indicate more intolerance for discomfort) and Breath Holding Duration Task (shorter durations indicate more intolerance for respiratory distress). The STAMP condition produced a greater rate of reduction in DIS scores than did the SCP condition. Changes in DIS scores during treatment mediated the effect of STAMP treatment on 7-day point prevalence abstinence at Month 3 post-quit attempt. There were no treatment conditions differences in changes in Breath-Holding duration. Data suggest self-reported distress intolerance is malleable in the context of stress sensitivity reduction treatment, but not standard smoking cessation treatment, and such reductions may result in promotion of smoking abstinence.

Exercise to Enhance Smoking Cessation: the Getting Physical on Cigarette Randomized Control Trial.

Exercise has been proposed as a useful smoking cessation aid. The purpose of the present study is to determine the effect of an exercise-aided smoking cessation intervention program, with built-in maintenance components, on post-intervention 14-, 26- and 56-week cessation rates. Female cigarette smokers (n = 413) participating in a supervised exercise and nicotine replacement therapy (NRT) smoking cessation program were randomized to one of four conditions: exercise + smoking cessation maintenance, exercise maintenance + contact control, smoking cessation maintenance + contact control or contact control. The primary outcome was continuous smoking abstinence. Abstinence differences were found between the exercise and equal contact non-exercise maintenance groups at weeks 14 (57 vs 43%), 26 (27 vs 21%) and 56 (26 vs 23.5%), respectively. Only the week 14 difference approached significance, p = 0.08. An exercise-aided NRT smoking cessation program with built-in maintenance components enhances post-intervention cessation rates at week 14 but not at weeks 26 and 56.

Multivariate Analysis of the questionnaire for Pharmacists who take a seminar of Smoking Cessation Intervention Program

Multivariate Analysis of the questionnaire for Pharmacists who take a seminar of Smoking Cessation Intervention Program

Pregnant smokers: Potential for improvement of intervention

Background In many countries, smoking is considered as the most important preventable risk factor for a complicated pregnancy and delivery. However in Denmark, there is no clear picture of pregnant women. The aim was therefore to examine the prevalence, characteristics and registration of maternal smoking and quitting during pregnancy as well as estimate the potential for improvement. Methods This is a cohort study on smoking and quitting prevalence among 422,221 pregnant women in Denmark from 2006- 2012. Data from the Danish National Birth Register was linked with data from the Danish National Smoking Cessation Database in order to identify pregnant smokers undertaking a formalised smoking cessation intervention. Results Overall, 13% of the pregnant women were smokers. The smoking prevalence was highest among mothers younger than 25 years of age (29%) compared to 10-11% among the other age groups. All prognostic factors in the final analyses were in some way associated with the outcome. A group of 1,279 pregnant women underwent formal smoking cessation intervention programs with follow-up after 6 months. Of these, 232 were registered as non-smokers and 40 had no information on smoking in the Danish National Birth Registry. The potential for reducing smoking among pregnant women was high. 25-32% more quitters would be expected with a comprehensive Gold Standard Programme for smoking cessation. Conclusion This study indicates an urgent need for increased focus on offering effective smoking cessation programs to all groups of pregnant smokers, but with a special attention to the youngest group.