Smoking Cessation Management Research Articles

Efficacy of non-invasive brain stimulation interventions in reducing smoking frequency in patients with nicotine dependence: a systematic review and network meta-analysis of randomized controlled trials.

Nicotine is a highly addictive substance in tobacco products that dysregulates several neurotransmitters in the brain and impairs executive function. Non-invasive brain stimulation (NIBS) methods such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are promising treatments for nicotine dependence. We investigated the efficacy and acceptability of NIBS in managing smoking cessation through a systematic review and network meta-analysis (NMA). We conducted a systematic review to identify randomized controlled trials (RCTs) that investigated the efficacy of NIBS for smoking cessation. All pairwise meta-analyses and NMA procedures were conducted using random-effects and frequentist models. The co-primary outcomes were (1) the change in number of cigarettes smoked per day (change in frequency of smoking) in patients with nicotine dependence after NIBS and (2) acceptability (the dropout rate). The effect sizes for co-primary outcomes of change in frequency of smoking and acceptability were assessed according to standardized mean difference (SMD) and odds ratio, respectively. Twelve RCTs with 710 participants (mean age: 44.2years, 31.2% female) were included. Compared with the sham control, 10-Hz rTMS over the left dorsolateral prefrontal cortex (DLPFC) was associated with the largest changes in smoking frequency [SMD=-1.22, 95% confidence interval (95% CI)=-1.77 to -0.66]. The 2-mA bifrontal tDCS (SMD=-0.97, 95% CI=-1.32 to -0.62) and 10-Hz deep rTMS over the bilateral DLPFC with cue provocation (SMD=-0.77, 95% CI=-1.20 to -0.34) were associated with a significantly larger decrease in smoking frequency versus the sham. None of the investigated NIBSs was associated with dropout rates significantly different from those of the sham control groups. Prefrontal non-invasive brain stimulation interventions appear to reduce the number of cigarettes smoked with good acceptability.

Screening cardiovascular risk factors of diabetes patients in the primary diabetes clinics.

To evaluate the atherosclerotic cardiovascular diseases (ASCVD) risk factors in type 2 diabetes patients from the primary diabetes clinics for further comprehensive intervention in China.A cross-sectional study was conducted in 5 primary diabetes chain hospitals in Beijing, Lanzhou, Harbin, Chengdu, and Taiyuan in continuous patients with type 2 diabetes from March 2016 to December 2019. The data collected at the first visit were analyzed, and proportions of patients reached the targets (glycosylated hemoglobin [HbA1c] < 7%, blood pressure < 130/80 mm Hg, and low-density lipoprotein cholesterol [LDL-C] < 2.6mmol/l) were calculated. The clinical characteristics and the associated factors with achievement in HbA1c, blood pressure, and LDL-C targets were analyzed.A total of 20,412 participants, including 11,353 men (55.6%), with an average age of (59.4 ± 10.4) years were enrolled. Nearly 95% diabetes had one or more ASCVD risk factors other than hyperglycemia. The control rates of HbA1c, blood pressure, and LDL-C were 26.5%, 27.8%, and 42.6%, respectively. Only 4.1% patients achieved all 3 targets. Nearly 95% patients had one or more ASCVD risk factors other than hyperglyciemia. Diabetes duration, family history, and overweight/obesity were associated with the number of aggregated ASCVD risk factors. The patients with older age, no overweight/obesity, not smoking, less ASCVD risk factors, and having special diabetes care insurance (Chengdu) were associated with a higher control rates.To deal with poor control status, global management of ASCVD risk factors, weight loss, and smoking cessation must be emphasized in the primary diabetes care settings. Special diabetes care insurance should be advocated.Current ClinicalTrial.gov protocol ID NCT03707379. Date of Registration: October 16, 2018. https://clinicaltrials.gov.

Antecedents and consequences of the perceived usefulness of smoking cessation online health communities

PurposeAn empirical study investigated the antecedents to perceived usefulness (PU) and its consequences in the context of smoking cessation online health communities (OHCs).Design/methodology/approachTo validate a research model for perceived informational support, perceived emotional support and perceived esteem support, the authors conducted a partial-least-squares analysis of empirical data from an online survey (N = 173) of users of two smoking cessation OHCs. The proposed model articulates these as antecedents to PU from a social support perspective, and knowledge sharing and continuance intention are expressed as consequences of PU.FindingsThe empirical study identified that the PU of smoking cessation OHCs is influenced by perceived emotional support and perceived esteem support, and perceived informational support indirectly affects PU via these factors. In turn, PU exerts a positive influence on both knowledge sharing and continuance intention. Also, knowledge sharing positively affects continuance intention.Originality/valueThe study contributes to scholarship on users' postadoption behavior in the context of smoking cessation OHCs by disentangling the antecedents to PU from a social support perspective and pinpointing some important consequences of PU. The research also has practical implications for managing smoking cessation OHCs.

Current trends in optimal medical therapy after PCI and its influence on clinical outcomes in China

BackgroundLimited data were available on the current trends in optimal medical therapy (OMT) after PCI and its influence on clinical outcomes in China. We aimed to evaluate the utilization and impact of OMT on the main adverse cardiovascular and cerebrovascular events (MACCEs) in post-PCI patients and analyzed the factors predictive of OMT after discharge.MethodsWe collected data from 3812 individuals from 2016.10 to 2017.09 at TEDA International Cardiovascular Hospital. They were classified into an OMT group and a non-OMT group according to their OMT status, which was defined as the combination of dual antiplatelet therapy, statins, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after PCI. Multivariable Cox regression models were developed to assess the association between OMT and MACCEs, defined as all-cause mortality, nonfatal myocardial infarction, stroke, and target vessel revascularization. A logistic regression model was established to analyze the factors predictive of OMT.ResultsOur results revealed that the proportion of patients receiving OMT and its component drugs decreased over time. A total of 36.0% of patients were still adherent to OMT at the end of follow-up. Binary logistic regression analysis revealed that baseline OMT (P < 0.001, OR = 52.868) was the strongest predictor of OMT after PCI. The Cox hazard model suggested that smoking after PCI was associated with the 1-year risk of MACCE (P = 0.001, HR = 2.060, 95% CI 1.346–3.151), while OMT (P = 0.001, HR = 0.486, 95% CI 0.312–0.756) was an independent protective factor against postoperative MACCEs.ConclusionsThere was still a gap between OMT utilization after PCI and the recommendations in the evidence-based guidelines. Sociodemographic and clinical factors influence the application of OMT. The management of OMT and smoking cessation after PCI should be emphasized.

Digital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review.

BackgroundCardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR.ObjectiveThe objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions.MethodsOur strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018.ResultsOur search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure.ConclusionsDigital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions.

Rheumatology health care providers' views and practices on obesity and smoking cessation management in rheumatoid arthritis.

To assess rheumatology health care providers' (HCPs) knowledge, beliefs, self-efficacy, practices, and perceived barriers pertaining to weight management and smoking cessation counselling in patients with rheumatoid arthritis (RA). We administered an online survey to collect self-reported data on rheumatology HCPs' knowledge, beliefs, self-efficacy, perceived barriers, and practices related to weight management and smoking cessation counselling. Participants were recruited through invitation emails (with anonymous survey links) sent by three Canadian rheumatology organizations. Fifty-nine rheumatology HCPs (15 nurses, 44 physicians) completed the survey (response rate: 11%). Over 85% correctly identified associations between obesity, or smoking, and more severe or active RA, as well as poorer response to treatment. All but one participant agreed that it was part of their responsibility to discuss these issues with patients, but 78% (46/59) felt not or slightly confident in their ability to help patients quit smoking or achieve clinically significant weight loss. The majority did not routinely assist patients in accessing appropriate resources or providers (only 42% did for obesity, 36% for smoking), send referrals (2-44%, depending on referral), or offer relevant educational materials (15% for obesity, 20% for smoking). Common barriers included competing demands and lack of time, training, access to expertise, and knowledge of available programs. Most rheumatology HCPs understood the implications of cigarette smoking and obesity in RA and accepted responsibility in addressing these issues. However, they lacked the time, training, confidence, and knowledge of local resources to do so effectively. There is a need to bridge this gap. Key Points • Training through medical and nursing school as well as residency on weight management and smoking cessation counselling was nearly unanimously described as poor or fair. • Most rheumatology health care providers understood the implications of cigarette smoking and obesity in rheumatoid arthritis and accepted responsibility in addressing these issues; however, they lacked the time, training, confidence, and knowledge of local resources to do so effectively. • There is a need to bridge the gap between health care providers' intentions and actions, and this may include the development of guides outlining local weight management and smoking cessation expertise, programs, referral processes, and educational materials.

COPD Maintenance Pharmacotherapy.

Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death worldwide and will likely be the third most common cause by the end of 2020. It is felt to be caused by repetitive noxious stimuli to the lung, most commonly from smoking, with persistent symptoms of cough, wheeze, and shortness of breath. Most patients will have these baseline symptoms, with periodic flare-ups known as exacerbations. This article focuses on pharmacological therapy in a stable COPD patient. Pharmacological treatment of a stable COPD patient focuses on minimizing symptoms, improving exercise tolerance, and preventing exacerbations. Nonpharmacological management of stable COPD, smoking cessation, and treatment of exacerbations are covered in other sections.

Abstract 14831: Racial Disparities and Modifiable Cardiovascular Risk Factors in Black Patients With Familial Hypercholesterolemia

Introduction: Black men and women are at higher risk for atherosclerotic cardiovascular disease (ASCVD) and when diagnosed, have greater morbidity and mortality as compared to individuals from European ancestry (EA). In patients with familial hypercholesterolemia (FH), it remains unknown whether Black patients have similarly increased risk for ASCVD. Hypothesis: To characterize the prevalence of ASCVD and to determine the strongest predictors of ASCVD in Black FH patients compared to EAs. Methods: The prevalence of ASCVD in 173 Black adult patients with FH followed in US-based lipid clinics was assessed retrospectively through a multicenter. A multivariate logistic regression model was used to determine the strongest predictors of ASCVD. Covariates included age, sex, diabetes mellitus, hypertension, and current smoking. ASCVD was defined as coronary, peripheral, and cerebrovascular events including angina, myocardial infarction, coronary angioplasty, peripheral arterial surgery, claudication, peripheral angioplasty, transient ischemic attack, stroke, and carotid endarterectomy. Results: Baseline characteristics of the 173 Black adult patients compared to EAs are shown in table 1. Black patients with FH were more likely to have higher BMI, hypertension, diabetes and to be current smokers. The prevalence of ASCVD in Black patients with FH was 38% compared to 30% in EAs, an absolute difference of 8% (p=0.047). The strongest predictors of ASCVD in Black patients with FH were hypertension and current smoking (table 2). Conclusions: Black patients with FH have a significantly higher prevalence of ASCVD when compared to EAs with FH. The strongest predictors of ASCVD in Black patients with FH were hypertension and current smoking. Aggressive primary prevention strategies specifically focused on the management of hypertension and smoking cessation should be tested for impact on the cardiovascular risk profile of Black patients with FH.

Good practice regarding smoking cessation management in Spain: Challenges and opportunities for primary care physicians and nurses.

INTRODUCTIONWe analyze the activities carried out by primary care (PC) physicians and nurses with respect to smoking cessation and evaluate their self-reported training, knowledge, and behavior.METHODSA cross-sectional study was conducted including 1514 PC physicians and nurses from June 2016 to March 2017, in Spain. The main variable was Good Practice (GP) in attention to smokers. To identify associated factors, a multilevel logistic regression model was used adjusted for sex, age, type of center, contract, years of employment, tobacco consumption, and self-reported training/knowledge.RESULTSOf the 792 physicians and 722 nurses, 48.6% referred to GP in smoking cessation management. The finding related to: being a non-smoker (OR=1.8; 95% CI: 1.2–2.5) or ex-smoker (OR=1.4; 95% CI: 1.02–2.1), having a good level of knowledge (OR=1.8; 95% CI: 1.3–2.4) and training (OR=2.4; 95% CI: 1.8–3.2), and, to a lesser extent, being female (OR=1.3; 95% CI: 1.03–1.7), and work experience >10 years (OR=1.4; 95% CI: 1.03–1.9). The main GP barriers were: lack of time (45.5%), organizational problems (48.4%), and 35.4% lack of training.CONCLUSIONSThe GP of PC physicians and nurses regarding smoking cessation management is related to being non-smokers or ex-smokers, and having sufficient training and knowledge. Lack of time and organizational problems were considered to be the main barriers. The promotion of training activities in the Spanish National Health Service with the support of scientific societies is required.

Smoking Is Associated With COVID-19 Progression: A Meta-analysis.

IntroductionSmoking depresses pulmonary immune function and is a risk factor contracting other infectious diseases and more serious outcomes among people who become infected. This paper presents a meta-analysis of the association between smoking and progression of the infectious disease COVID-19.MethodsPubMed was searched on April 28, 2020, with search terms “smoking”, “smoker*”, “characteristics”, “risk factors”, “outcomes”, and “COVID-19”, “COVID”, “coronavirus”, “sar cov-2”, “sar cov 2”. Studies reporting smoking behavior of COVID-19 patients and progression of disease were selected for the final analysis. The study outcome was progression of COVID-19 among people who already had the disease. A random effects meta-analysis was applied.ResultsWe identified 19 peer-reviewed papers with a total of 11,590 COVID-19 patients, 2,133 (18.4%) with severe disease and 731 (6.3%) with a history of smoking. A total of 218 patients with a history of smoking (29.8%) experienced disease progression, compared with 17.6% of non-smoking patients. The meta-analysis showed a significant association between smoking and progression of COVID-19 (OR 1.91, 95% confidence interval [CI] 1.42-2.59, p = 0.001). Limitations in the 19 papers suggest that the actual risk of smoking may be higher.ConclusionsSmoking is a risk factor for progression of COVID-19, with smokers having higher odds of COVID-19 progression than never smokers.ImplicationsPhysicians and public health professionals should collect data on smoking as part of clinical management and add smoking cessation to the list of practices to blunt the COVID-19 pandemic.

Assessment of Physicians’ Knowledge, Attitudes, and Practices Regarding Smoking Cessation Management in the Gaza Strip

Background: Despite its negative effects, approximately 23% of Palestinians (≥ 18 years) smoke cigarettes. Studies have shown physicians to be an important channel for smoking cessation intervention. This investigation examines physicians’ smoking-related knowledge, attitudes, and behaviors in the Gaza strip (Palestinian Territories). Methods and Findings: A convenience sample of 154 physicians in medical and surgical units took part in this investigation (87.7% response rate). The data show that 37.8% of physicians in Gaza smoke, and most of them about 72% smoke in the hospital’s public spaces, thereby implicitly giving public approval for smoking. While 82.4% reported that they advise patients who smoke to stop, the majority (59%) also believe that their own smoking habits negatively influence the impact of that advice. Unfortunately, our survey showed that physicians’ knowledge levels towards smoking addiction and management were lower than expected (e.g. only 34% knew that nicotine dependence is a psychiatric disorder that necessitates treatment). The physicians in this study believed that the primary barriers to failure of their patients’ smoking cessation were the perceived lack of will (81.3%), and the strength of patients’ addiction (67.9%). Moreover, (61%) of physicians did not spend enough time to convince their patients to quit smoking. Conclusion: Smoking is common among Gaza-strip physicians, and unfortunately, most of them smoke in the hospital’s public spaces. Many obstacles face the smoking cessation program that some physicians linked it to patients, and others linked it to the health-care system. Furthermore, smokers in Gaza receive poor care regarding assessment, referral, and management of their smoking habit.

Assessment of physicians’ knowledge, attitudes, and practices regarding smoking cessation management in the Gaza Strip

Assessment of physicians’ knowledge, attitudes, and practices regarding smoking cessation management in the Gaza Strip

An evaluation of the impact of aggressive hypertension, diabetes and smoking cessation management on CVD outcomes at the population level: a dynamic simulation analysis

BackgroundEvidence from randomized control trials suggest that coupled with smoking cessation interventions, CVD events can be reduced significantly if hypertension and diabetes patients are properly managed, raising practical what-if questions at the population level. This research aims to develop a dynamic simulation model using the systems modelling methodology of system dynamics, to evaluate the medium to long-term impact of hypertension and diabetes management, as well as smoking cessation intervention on CVD events, CVD deaths and post-CVD population.MethodsThe systems modelling methodology of system dynamics was used to develop a simulation model to evaluate the impact of aggressive hypertension, diabetes and smoking cessation management on CVD outcomes at the population level.ResultThe insights from this research suggest that despite that at the individual level, hypertension management is associated with the highest risk reduction for CVD (50%) compared to diabetes and smoking (20%) and is also the most prevalent risk factor, at the population level, diabetes management interventions are projected to have higher impact on reducing CVD events compared to hypertension management or smoking cessation interventions. However, a combined intervention of diabetes and hypertension management, as well as smoking cessation has the most impact on CVD outcomes.ConclusionDue to aging population and the increasing prevalence of chronic conditions in Singapore, the number of CVD events in Singapore is projected to rise significantly in the near future—hence the need for proactive planning to implement needed interventions. Findings from this research suggest that CVD events and its associated deaths and disabilities could be reduced significantly if diabetes and hypertension patients are aggressively managed.

Association Between Nicotine-dependent Gene Polymorphism and Smoking Cessation in Patients With Lung Cancer

BackgroundPatients with lung cancer continue to smoke owing to complex factors. Failure to quit smoking (defined as nicotine dependence) is significantly associated with genetic status. This study aimed to investigate the relationship between polymorphisms in nicotine dependence genes and smoking status after the diagnosis of lung cancer. Patients and MethodsA total of 240 patients with lung cancer were included from July 2017 to March 2018. According to the actual smoking condition after lung cancer diagnosis, eligible patients were divided into 3 groups: the never-smoking group, the failure to quit smoking group, and the successful smoking cessation group. Fagerstrom Test for Nicotine Dependence scores were used to evaluate the smoking status of each group. Three nicotine-dependent genes with 6 loci were detected. ResultsAmong the 240 patients, 86 were never-smokers, 51 failed to quit smoking, and 104 successfully quit smoking. The initial age of smoking in the failure to quit smoking group was significantly younger than those in the successful smoking cessation group (P = .001). There was a significant difference in the GG and AG and AA genotype distributions of CHRNA3 (rs578776) among the 3 groups (P = .003). There was also a significant difference in the distribution of CHRNA4 (rs2229959) genotypes among the 3 groups (P = .003). However, there was no significant difference in the genotype distribution of CHRNA5 (rs588765) among the 3 groups (P = .277). ConclusionsGene polymorphisms of CHRNA3 (rs578776) and CHRNA4 (rs1044396 and rs2229959) were associated with the success of smoking cessation after the diagnosis of lung cancer, which should be considered in the management of smoking cessation after patients are diagnosed with lung cancer.

Incidence of comorbidities on death certificate data in women with gynecological cancers.

e17127 Background: Risk factors for the development of gynecological cancers are known to vary; however, the effect on mortality is uncertain. Methods: Using CDC Wonder Database, death certificate data, all women who died of cancer in the United States from 2003-2016 were included if a cancer diagnosis was listed as a primary or contributing cause. Cases were then divided into gynecological (GYN) cancer or not, and thereafter characterized as cervical, ovarian, uterine, or other. Other causes contributing to death (comorbidities were then captured via ICD10 codes listed on death certificates and grouped into similar disease states. Chi-squared and Mann-Whitney U tests were performed for statistical significance. Results: Of 35,324,091 death certificates, 4,177,823 deaths were women with cancer listed as a cause of death. 440,792 were gynecological cancer, with cervical cancer in 62,807; uterine cancer in 134,420; ovarian cancer in 221,119; and other gynecological cancers in 25,946. Women with GYN cancers were more likely to have intestinal obstruction (2.7% vs 0.7%, OR 4.05), ascites (0.7% vs 0.2%, OR 3.30), HIV (0.1% vs 0.05%, OR 1.53), kidney disease (4.7% vs 3.6%, OR 1.33), and thrombo-embolic disorders (4.3% vs 3.5%, OR 1.25) when compared to non-GYN cancers (all p &lt; 0.00001). Uterine cancer was more likely to have diabetes-related comorbidities (6.4% vs 3.8%, OR 1.75), metabolic syndrome (9.5% vs 6.1%, OR 1.60), thrombo-embolic disorders (5.5% vs 3.8%, OR 1.48), ischemic heart disease (5.0% vs 3.6%, OR 1.43), than other GYN cancers (all p &lt; 0.00001). Cervical cancer was more associated with HIV (0.3% vs 0.03%, OR 10.73) and tobacco-related disorders (4.7% vs 1.9%, OR 2.56). Ovarian cancer was more associated with ascites (1.1% vs 0.4%, OR 2.93), intestinal obstruction (3.5% vs 1.8%, OR 2.04), and pleural effusion (1.1% vs 0.6%, OR 1.92) (all p &lt; 0.00001). Conclusions: Comorbidities contributing to death significantly differ amongst gynecological cancers and non-gynecological cancers, which has relevance to strategies that can be differentially employed to reduce mortality. In particular, women with uterine cancer may benefit from reduction in risk of diabetes, ischemic heart disease, and embolic disorders; those with cervical cancer may benefit from smoking cessation and optimal HIV management.

Factors related to age at menopause among Korean women: the Korean Longitudinal Survey of Women and Families.

The purpose of this study was to explore factors influencing age of menopause among Korean women. For this secondary analysis study, panel data for Waves 4 through 6 of the Korean Longitudinal Survey of Women were used. Women aged 40 to 60 who were menstruating at Wave 4 were included in the analysis (N = 5,437). Sociodemographic, health status, and health behavioral factors were examined to explore their influence on menopause using Kaplan-Meier analysis and Cox regression analysis. Korean women who perceived themselves to be overweight or obese, who had depressive symptoms, or who smoked or were current smokers had higher probabilities of experiencing the onset of menopause, whereas those who had educational achievement lower than high school had a lower probability of experiencing the onset menopause. Various factors influenced menopause, including sociodemographic, health status, and health behaviors. Specific tailored interventions for the management of depressive symptoms and smoking cessation could be developed to target modifying variables for Korean women, in preparation for menopause. Also, the role of perceived body weight on menopause could be further explored to identify sociocultural factors for age at menopause.

Incentivizing healthy lifestyle behaviors to reduce cardiovascular risk in people with serious mental illness: An equipoise randomized controlled trial of the wellness incentives program

BackgroundMedicaid recipients with serious mental illness die 25–30 years earlier than people in the general population due to health conditions that are modifiable through lifestyle changes. Cardiovascular diseases from excess weight, smoking, and sedentary lifestyle contribute substantially to this life expectancy disparity. The current study evaluated the impact of incentives on participation in weight management programming (for overweight and obese adults) and smoking cessation treatment (for regular smokers). MethodsParticipants were Medicaid recipients with disabling mental illness receiving services at any one of 10 community mental health centers across New Hampshire. Using an equipoise stratified randomized design, n = 1348 were enrolled and assigned to one of four weight management programs (Healthy Choices Healthy Changes: HCHC) and n = 661 were enrolled and assigned to one of three smoking cessation interventions (Breathe Well Live Well: BWLW). Following assignment to an intervention, participants were randomized to receive financial incentives (to attend weight management programs, or to achieve abstinence from smoking) or not. Data were collected at baseline and every 3 months for 12 months. DiscussionNew Hampshire's HCHC and BWLW programs were designed to address serious and preventable health disparities by providing incentivized health promotion programs to overweight/obese and/or tobacco-smoking Medicaid beneficiaries with mental illness. This study was an unprecedented opportunity to evaluate an innovative statewide implementation of incentivized health promotion targeting the most at-risk and costly beneficiaries. If proven effective, this program has the potential to serve as a national model for widespread implementation.

Digital Education for Health Professions on Smoking Cessation Management: Systematic Review by the Digital Health Education Collaboration.

BackgroundTobacco smoking, one of the leading causes of preventable death and disease, is associated with 7 million deaths every year. This is estimated to rise to more than 8 million deaths per year by 2030, with 80% occurring in low- and middle-income countries. Digital education, teaching, and learning using digital technologies have the potential to increase educational opportunities, supplement teaching activities, and decrease distance barriers in health professions education.ObjectiveThe primary objective of this systematic review was to evaluate the effectiveness of digital education compared with various controls in improving learners’ knowledge, skills, attitudes, and satisfaction to deliver smoking cessation therapy. The secondary objectives were to assess patient-related outcomes, change in health professionals’ practice or behavior, self-efficacy or self-rated competence of health professionals in delivering smoking cessation therapy, and cost-effectiveness of the interventions.MethodsWe searched 7 electronic databases and 2 trial registers for randomized controlled trials published between January 1990 and August 2017. We used gold standard Cochrane methods to select and extract data and appraise eligible studies.ResultsA total of 11 studies (number of participants, n=2684) were included in the review. All studies found that digital education was at least as effective as traditional or usual learning. There was some suggestion that blended education results in similar or greater improvements in knowledge (standardized mean difference, SMD=0.19, 95% CI −0.35 to 0.72), skill (SMD=0.58, 95% CI 0.08-1.08), and satisfaction (SMD=0.62, 95% CI 0.12-1.12) compared with digital education or usual learning alone. There was also some evidence for improved attitude (SMD=0.45, 95% CI 0.18-0.72) following digital education compared with usual learning. Only 1 study reported patient outcomes and the setup cost of blended education but did not compare outcomes among groups. There were insufficient data to investigate what components of the digital education interventions were associated with the greatest improvements in learning outcomes.ConclusionsThe evidence suggests that digital education is at least as effective as usual learning in improving health professionals’ knowledge and skill for delivering smoking cessation therapy. However, limitations in the evidence base mean that these conclusions should be interpreted with some caution.Trial RegistrationPROSPERO CRD42016046815; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=46815

Dimensions of impulsive behavior: Predicting contingency management treatment outcomes for adolescent smokers

BackgroundBehavioral measures of impulsive behavior include the dimensions of behavioral disinhibition, decision-making, and lapses of attention. These behaviors are associated with a range of risky activities during adolescence, including cigarette smoking; however, few studies have evaluated their associations with tobacco treatment outcomes. The current study examined the relationship between impulsive behavior and contingency management treatment outcomes for adolescent smokers. MethodsData from two contingency management smoking cessation trials were combined (N = 189 adolescents). Participants provided breath carbon monoxide (CO) samples with incentives delivered contingent (i.e., active treatment [AT] condition) or non-contingent (i.e., control treatment [CT] condition) on CO level. Dimensions of impulsive behavior were assessed pre- and post-treatment using the Go/Stop Task, a measure of delay discounting, a continuous performance task, while self-reported impulsivity was assessed with the Barratt Impulsiveness Scale-Adolescent. Relationships between impulsive behavior and treatment outcomes (efficacy and adherence) were assessed using linear mixed effects models. ResultsParticipants in the AT condition had significantly lower program CO levels at each treatment phase. Delay discounting in the AT condition predicted CO levels, with those discounting the most lowering their breath CO levels the least. Delay discounting also predicted program adherence across both conditions. ConclusionsDelay discounting may be the most relevant dimension of impulsive behavior to predict outcomes for adolescent smokers completing CM programs, both in terms of successful reductions in smoking and program adherence. Suggestions are made to reduce the effects of delay discounting for adolescent smokers using this treatment approach.

Lifestyle Medicine: The Health Promoting Power of Daily Habits and Practices.

There is no longer any serious doubt that daily habits and actions profoundly affect both short-term and long-term health and quality of life. This concept is supported by literally thousands of research articles and incorporated in multiple evidence-based guidelines for the prevention and/or treatment of chronic metabolic diseases. The study of how habits and actions affect both prevention and treatment of diseases has coalesced around the concept of "lifestyle medicine." The purpose of this review is to provide an up-to-date summary of many of the modalities fundamental to lifestyle medicine, including physical activity, proper nutrition, weight management, and cigarette smoking cessation. This review will also focus specifically on how these modalities are employed both in the prevention and treatment of chronic diseases including coronary heart disease, diabetes, obesity, and cancer. The review concludes with a Call to Action challenging the medical community to embrace the modalities of lifestyle medicine in the daily practice of medicine.