Smoking Cessation Medications Research Articles

Examining Racial/Ethnic Disparities in Tobacco Dependence Treatment Among Medicaid Beneficiaries Using Fifty State Medicaid Claims, 2009-2014.

In the USA, low-income racial/ethnic minority groups experience higher smoking rates and greater smoking-related disease burden than their White counterparts. Despite the adverse effects, racial/ethnic minorities are less likely to access tobacco dependence treatment (TDT). Medicaid is one of the largest payers of TDT in the USA and covers predominantly low-income populations. The extent of TDT use among beneficiaries from distinct racial/ethnic groups is unknown. The objective is to estimate racial/ethnic differences in TDT use among Medicaid fee-for-service beneficiaries. Using a retrospective study design and 50 state (including the District of Columbia) Medicaid claims (2009-2014), we employed multivariable logistic regression models and predictive margin methods to estimate TDT use rates among adults (18-64) enrolled (≥ 11months) in Medicaid fee-for-service programs (January 2009-December 2014) by race/ethnicity. The population included White (n = 6,536,004), Black (n = 3,352,983), Latinx (n = 2,264,647), Asian (n = 451,448), and Native American/Alaskan Native (n = 206,472) beneficiaries. Dichotomous outcomes reflected service use in the past year. Any TDT use was operationalized as any smoking cessation medication fill, any smoking cessation counseling visit, or any smoking cessation outpatient visit. In secondary analyses, we disaggregated TDT use into three separate outcomes. Results suggested that Black (10.6%; 95% CI = 9.9-11.4%), Latinx (9.5%; 95% CI = 8.9-10.2%), Asian (3.7%; 95% CI = 3.4-4.1%), and Native American/Alaskan Native (13.7%; 95% CI = 12.7-14.7%) beneficiaries had lower TDT use rates compared to White beneficiaries (20.6%). Similar racial/ethnic treatment disparities were identified across all outcomes. By identifying significant racial/ethnic disparities in TDT use between 2009 and 2014, this study provides a benchmark against which to measure recent interventions in state Medicaid programs improving equity in smoking cessation interventions.

Effectiveness of Different Types of Smoking Cessation Health Education for Preoperative Patents and the Factors Correlated with Cessation Success Rate

<p>目的：探討預計接受手術之病人接受不同戒菸衛教方式之戒菸成功率與影響因子分析。</p> <p>方法：本研究為臨床介入前瞻性隨機分配研究。研究對象為2016年10月至2020年1月某醫學中心預計進行常規手術的吸菸病人，隨機分配為影片衛教組及單張衛教組，進行戒菸衛教介入，並分別於戒菸衛教介入後三個月、六個月、十二個月以電話追蹤個案的吸菸狀況，監測點戒菸成功率。以統計方式分析兩組類別變項差異，以及與點戒菸成功率之相關性。</p> <p>結果：本研究共收案79人（接受單張衛教組為44人，男性佔95.5%，平均年齡為49.47±13.52歲；接受影片衛教組為35人，男性佔100%，平均年齡為49.25±12.96歲）。結果顯示戒菸成功率，在3個月點戒菸成功率中，影片衛教組顯著高於單張衛教組，但在6個月及12個月點戒菸成功率則無顯著差異。進一步以羅吉斯迴歸分析發現有使用戒菸藥物者其手術前戒菸衛教3個月點戒菸成功率較高，有糖尿病者手術前戒菸衛教3個月點戒菸成功率較低。而術前接受單張衛教介入者3個月點戒菸成功率較接受影片衛教者低。12個月點戒菸成功率部分則發現罹患心血管疾病者、罹患癌症者其手術前戒菸衛教12個月點戒菸成功率較高；吸菸時間較長者其手術前戒菸衛教12個月點戒菸成功率較低。</p> <p>結論：手術前接受戒菸衛教能提升戒菸意願，增加戒菸成功率，其中使用傳統衛教單張作為戒菸衛教的媒材相較於衛教影片的戒菸成功率低，故也許能嘗試使用衛教影片作為媒材以期提升短期戒菸成功率。</p> <p> </p><p>Purpose: To explore the success rates and influencing factors of different smoking cessation education methods among patients scheduled for surgery.</p> <p>Methods: This study is a clinical intervention prospective randomized controlled trial. The study population consisted of smokers scheduled for elective surgery at a medical center between October 2016 and January 2020. Participants were randomly assigned to either a video education group or a pamphlet education group for smoking cessation intervention. Follow-ups were conducted via phone at three months, six months, and twelve months after the intervention to monitor smoking status and assess point cessation success rates. Statistical analyses were performed to compare categorical variables between the two groups of participants and assess correlations with point cessation success rates.</p> <p>Results: A total of 79 participants were enrolled (44 in the pamphlet education group, 95.5% male, mean age 49.47±13.52 years; 35 in the video education group, 100% male, mean age 49.25±12.96 years). Results indicated that, at the 3-month follow-up, the video education group exhibited a significantly higher smoking cessation success rate than the pamphlet education group. However, no significant differences were observed at the 6-month and 12-month follow-ups. Further analysis using logistic regression revealed that individuals using smoking cessation medication reported a higher smoking cessation success rate at the 3-month follow-up after preoperative smoking cessation education; the success rate, however, was lower for diabetes patients. Moreover, the success rate at the 3-month follow-up remained lower in those receiving pamphlet education as compared to those receiving video education. At the 12-month follow-up, the success rate after operative smoking cessation education was higher among participants with cardiovascular disease and cancer but lower in those with a longer smoking history. </p> <p>Conclusion: Preoperative smoking cessation education enhances the motivation and success rates of smoking cessation for patients scheduled for surgery, and traditional health education pamphlets appear to be less effective than health education videos. Therefore, it may be worth trying health education videos as a medium to enhance short-term smoking cessation success rates.</p> <p> </p>

The role of sex hormones in targeting stress-induced tobacco craving, stress-reactivity, and smoking with guanfacine among women who smoke

Women who smoke are particularly vulnerable to tobacco craving, smoking behaviors, and relapse in the context of stress when compared to men who smoke. One factor in this sex difference may be sex hormones, including estradiol and progesterone; however, smoking cessation medication trials often do not explore the impact of sex hormones on drug effects. This secondary analysis of a double-blind, placebo-controlled study explored the impact of levels of actual estradiol and progesterone on guanfacine, a noradrenergic α2a agonist, which attenuates stress-induced smoking behaviors in women. Women who smoke (n = 43) completed a stress induction laboratory paradigm followed by an ad-libitum smoking period. Assessment of tobacco craving, and stress-reactivity (via cortisol response) occurred pre- and post-stress induction. Results indicated that guanfacine attenuated stress-induced tobacco craving (F = 10.94, p = 0.02) and cortisol response (F = 14.23, p < 0.001); however, high levels of estradiol overrode guanfacine's effect on craving (F = 4.00, p = 0.05), cortisol response (F = 14.23, p < 0.001), and smoking during the ad-libitum period (F = 12.23, p = 0.001). Additionally, progesterone proved to be protective against tobacco craving and enhanced guanfacine's medication effect on craving (F = 5.57, p = 0.02). The present study found that sex hormones had a significant impact on medication effects in a smoking cessation trial and thus underscore the importance of examining the role of sex hormones in future medication trials.

Safety and efficacy of early varenicline prescription in hospitalized patients with acute myocardial infarction: East Asian population

Smoking is a strong risk factor for patients with acute myocardial infarction (AMI). Varenicline is commonly used as a smoking cessation medication, but little is known about its usage in patients with AMI, particularly in hospitalized patients. This is a prospective observational, single-center study collected from May 2018 to July 2021. Study patients underwent percutaneous coronary intervention for AMI.The primary end point was set as safety of varenicline, focusing on any serious adverse cardiac events within 24 weeks after treatment. Efficacy of smoking abstinence was also assessed through self-reports of complete abstinence over a week before the 24- week clinic visit. A total of 162 patients hospitalized with AMI were enrolled in our study. Mean age was 56.7 ± 9.95 years and 97% of the patients were male. Most patients (93.2%) received their first dose of varenicline during hospitalization. Time from admission to first dose of study medication was 2.31 ± 2.73 days and duration of drug intake was 7.41 ± 5.18 weeks. At week 24, only one patient had recurrent myocardial infarction, five patients had undergone revascularization for target lesion failure, and no additional patients developed stroke or died. In terms of efficacy, the rate of smoking abstinence was 79%. Light smokers found it easier to quit smoking than heavy smokers. This study may represent the first report on the safety and efficacy of early initiation of varenicline treatment in East Asian population hospitalized due to AMI who recently underwent percutaneous coronary intervention.

An intervention study on a hospital-community integrated management model of tobacco dependence based on a community intervention trial.

To assess the effect of the hospital-community integrated management model of tobacco dependence on smoking cessation among community residents compared with a brief smoking cessation intervention. Our study recruited 651 smokers who were willing to quit in 19 communities in Beijing and conducted a 6-month smoking cessation intervention. The control group receiving a brief smoking cessation intervention and the pilot group receiving an integrated smoking cessation intervention. Intention-to-treat analysis (ITT) and generalized estimating equations were used to assess the effects of the integrated intervention and smoking cessation medication on average number of cigarettes smoked per day (ACSD) and smoking cessation rate. Simple effects analysis showed that smokers taking medication had significantly lower ACSD than those not taking medication at follow-up, the control group reduced smoking by 3.270, 4.830, and 4.760 cigarettes in the first, third and sixth months, respectively, while the pilot group reduced by 6.230, 5.820, and 4.100 cigarettes. The integrated intervention significantly reduced ACSD among medication-taking smokers at 1st month (reduced by 3.420, P < 0.05) and 3rd month (reduced by 2.050, P < 0.05), but had no significant effect among non-medication taking smokers. The 3rd month smoking cessation rate among medication-taking smokers was 27.0%, which was significantly higher than the smokers with brief smoking cessation intervention. The integrated hospital-community intervention can significantly promote smoking cessation among smokers taking medication, but the issue of payment for medication and additional labor compensation for medical staff should be addressed before its popularization.

Comparison of a Daily Smartphone App and Retrospective Questionnaire Measures of Adherence to Nicotine Replacement Therapy Among Pregnant Women: Observational Study.

Few studies have investigated how to best measure adherence to smoking cessation medications, but continuous usage measures are recommended. In this first study of its kind, we compared methods for measuring adherence to nicotine replacement therapy (NRT) among pregnant women, investigating the completeness and validity of data collected from daily assessments using a smartphone app versus data collected from retrospective questionnaires. Women aged ≥16 years who were daily smokers and <25 weeks pregnant were offered smoking-cessation counseling and encouraged to use NRT. For 28 days after setting a quit date (QD), women were asked to report NRT use daily to a smartphone app and to questionnaires administered in person or remotely at 7 and 28 days. For both data collection methods, we provided up to £25 (~US $30) as compensation for the time taken providing research data. Data completeness and NRT use reported to the app and in questionnaires were compared. For each method, we also correlated mean daily nicotine doses reported within 7 days of the QD with Day 7 saliva cotinine concentrations. Of the 438 women assessed for eligibility, 40 participated and 35 accepted NRT. More participants (31/35) submitted NRT usage data to the app by Day 28 (median 25, IQR 11 days) than completed the Day 28 questionnaire (24/35) or either of the two questionnaires (27/35). Data submitted to the app showed a lower reported duration of NRT use compared to that indicated in the questionnaire (median for app 24 days, IQR 10.25; median for questionnaire 28 days, IQR 4.75; P=.007), and there appeared to be specific cases of overreporting to the questionnaire. Mean daily nicotine doses between the QD and Day 7 were lower when calculated using app data (median for app 40 mg, IQR 52.1; median for questionnaire 40 mg, IQR 63.1; P=.001), and some large outliers were evident for the questionnaire. Mean daily nicotine doses, adjusted for cigarettes smoked, were not associated with cotinine concentrations for either method (app rs=0.184, P=.55; questionnaire rs=0.031, P=.92), but the small sample size meant that the analysis was likely underpowered. Daily assessment of NRT use via a smartphone app facilitated more complete data (a higher response rate) than questionnaires, and reporting rates over 28 days were encouraging among pregnant women. App data had better face validity; retrospective questionnaires appeared to overestimate NRT use for some participants.

How do patients and staff in an opioid agonist treatment service view smoking cessation medications and e-cigarettes?

Tobacco use and related mortality is common in people receiving opioid agonist treatment (OAT). Smoking cessation medications are available and e-cigarettes are increasingly recommended for high risk populations. This study explores experience, knowledge and attitudes around smoking cessation medications (nicotine replacement therapy [NRT], bupropion and varenicline) and e-cigarettes in patients and clinicians in two public Australian OAT clinics. Cross-sectional surveys of patients and clinicians and a randomly sampled retrospective medical record review. Patients were recruited through an advertisement in the clinic, and clinicians through advertisement at an educational session. Ninety-one patients and 10 clinicians completed the surveys. Most patients had at least one quit attempt and 43% were currently trying to quit. There were high levels of exposure to NRT, lower levels with varenicline and very limited exposure to bupropion. Patients considered e-cigarettes most helpful, but were more likely to consider using NRT. Few patients reported smoking cessation interventions from their clinicians. Most clinicians identified high tobacco use prevalence, considered this problematic, but reportedlow rates of smoking cessation intervention. NRT was the preferred medication. E-cigarettes were not considered helpful. Sixty-six percent of the 140 records reviewed documented patients as smokers. Tobacco cessation medication was rarely discussed or provided. Patients report high rates of tobacco cessation planning, but low rates of intervention. Experience of varenicline and bupropion is limited. E-cigarettes were preferred over varenicline and bupropion. Improving patient's and clinician's knowledge oftobacco cessation medications could improve smoking cessation interventions and uptake of approved medications.

Varenicline induced auditory hallucinations in a young female with bipolar disorder: a case report

IntroductionCreating appropriate and sustainable treatment plans for patients with concurrent disorders presents a challenge to psychiatrists and addiction medicine specialists alike. Although varenicline has been found to be one of the most effective medications for smoking cessation and abstinence, caution is needed when starting patients on this medication. In this case, a young female provisionally diagnosed with bipolar I disorder was hospitalized for a manic episode in the context of substance abuse and medical noncompliance. She also endorsed a long history of smoking, alcohol, cocaine, cannabis and ketamine use. In addition to being stabilized for bipolar disorder, the patient was started on varenicline for smoking cessation on Day 14 of admission.ObjectivesThis case report highlights the potential risk of de-stabilization in a vulnerable youth with newly diagnosed bipolar I disorder and precarious social circumstances, in attempts to further concurrent approaches to psychiatric care.MethodsIn addition to qualitative observations, the main objective exam used to track patient progress through the duration of her hospitalization was the mental status exam (MSE). This is standard practice for psychiatric care and qualitatively assessed factors related to a patient’s behavioral and cognitive functioning. Important factors assessed for this patient include appearance and behavior, speech, affect and mood, thought form, thought content, perceptual abnormalities, insight and cognition.ResultsPerceptual abnormalities, including auditory hallucinations, were not recorded at admission and the patient’s symptoms of mania were resolving clinically on Day 18. Two days after starting varenicline, the patient developed auditory hallucinations, paranoia and referential beliefs. However, her insight was intact, and she had minimal thought-form disorganization. The patient also reported hearing auditory hallucinations of a derogatory nature, with her mood appearing more distressed during varenicline use. Symptoms were found to be resolved shortly after the discontinuation of varenicline on Day 18 and the patient appeared to be less distressed on following days. In this case, these symptoms were not in keeping with her bipolar diagnosis and thought to be secondary to varenicline after the consideration of potential alternative contributors.ConclusionsThe occurrence of side effects as a result of varenicline use in patients with diagnosed mental health conditions is rare and underlying psychiatric illness is not labeled as an absolute contraindication in the prescription of varenicline. However, it is important to advocate for increased guidance and research on the treatment of substance use disorders in patients with bipolar I disorder.Disclosure of InterestNone Declared

Factors associated with quitting among smoking cessation medication-assisted smokers and ex-smokers: A cross-sectional study in Australia

Effective smoking cessation medications (SCM) are available and are recommended for the treatment of tobacco smoking. In this study, we evaluated rate and factors associated with successful quitting among individuals who supported their quit attempt using SCMs in Australia. An observational online cross-sectional survey was conducted using a convenience sample of smokers and ex-smokers in Australia. A self-administered questionnaire was used to evaluate socio-demographic, psychological, smoking, and medication use characteristics. The Fagerstrom Test for Nicotine Dependence scale was used to assess the level of nicotine addiction. Logistic regression used to identify factors associated with smoking cessation. Of the 201 respondents, 33.3% had successfully quit smoking. Nicotine replacement therapy (NRT), varenicline, and bupropion were used by 71.6%, 19.9%, and 8.5% respectively. The rate of quitting was 30.6%, 47.5%, and 23.5% for participants who used NRT, varenicline, and bupropion, respectively. Six in ten (59.6%) of the participants who were adherent to SCMs reported continuous abstinence. Whereas 22.9% reported quitting among participants who were nonadherent to SCMs. Adherence to SCMs was significantly associated with increased rate of quitting (AOR = 2.67, 95% CI of 1.17–6.10). Additionally, having smoke-free home was associated with successful smoking cessation (AOR = 2.34, 95% CI of 1.13–4.90). In conclusion, one in three participants self-reported that they successfully quit smoking. Adherence to SCMs and smoke-free home were strongly associated with quitting. Smoking cessation programs and future studies are recommended to incorporate medication adherence as a core component. Home-targeted and family-inclusive interventions are recommended to manage smoke-free homes and enhance success of quitting attempts.

Receipt of Smoking Cessation Medications Among People With and Without Human Immunodeficiency Virus in the Veterans Aging Cohort Study (2003-2018).

Nicotine replacement therapy, bupropion, and varenicline are smoking cessation medications (SCMs) shown to be similarly effective in people with and without human immunodeficiency virus (PWH and PWoH, respectively), although rates of receipt of these medications are unknown. We identified patients in the Veterans Aging Cohort Study with electronic health record-documented current smoking using clinical reminder data for tobacco use (2003-2018). We measured receipt of SCMs using Veterans Affairs pharmacy data for outpatient prescriptions filled 0-365 days after current smoking documentation. We used log-linear, Poisson-modified regression models to evaluate the relative risk (RR) for receiving SCM by human immunodeficiency virus (HIV) status, the annual rate of receipt, and rate difference among PWH relative to PWoH. The sample included 92 632 patients (29 086 PWH), reflecting 381 637 documentations of current smoking. From 2003 to 2018, the proportion receiving SCMs increased from 15% to 34% for PWH and from 17% to 32% among PWoH. There was no statistical difference in likelihood of receiving SCM by HIV status (RR, 1.010; 95% confidence interval [CI], .994-1.026). Annual rates of receiving SCM increased for PWH by 4.3% per year (RR, 1.043; 95% CI, 1.040-1.047) and for PWoH by 3.7% per year (RR, 1.037; 95% CI, 1.036-1.038; rate difference +0.6% [RR, 1.006; 95% CI, 1.004-1.009]). In a national sample of current smokers, receipt of SCM doubled over the 16-year period, and differences by HIV status were modest. However, fewer than 35% of current smokers receive SCM annually. Efforts to improve SCM receipt should continue for both groups given the known dangers of smoking.

Abstract WMP40: Patterns And Predictors Of Smoking Cessation Pharmacotherapy Provision After Stroke And Transient Ischemic Attack: Findings From The Get With The Guidelines-Stroke Registry

Introduction: We analyzed data regarding smoking cessation medication use after stroke/TIA in the United States. Methods: We performed a retrospective analysis using data from the Get With The Guidelines®-Stroke registry, which includes data for adult patients receiving acute care for stroke and TIA across the United States. Our outcome of interest was provision of cessation medication (nicotine replacement therapy [NRT], bupropion, varenicline) among patients who were active smokers at the time of stroke/TIA. We used unadjusted and multivariable regression models to explore factors associated with provision of cessation medications. We specifically evaluated whether event type (TIA and hemorrhagic stroke versus ischemic stroke) and burden of smoking-related cardiovascular conditions (≥1 versus 0) were associated with cessation medication provision. Results: Of 1,589,760 patients with stroke/TIA, 187,501 were smokers with available smoking treatment data. The mean age was 59.9 years (SD, 11.6); 42% were women. Most patients (97.7%) received some form of cessation intervention. As for specific treatments, 29.8% were provided cessation medication (NRT: 16.2%; varenicline or bupropion: 13.0%; multiple/other: 2.3%). The remaining 68.5% received counseling alone. In multivariable models, patients with hemorrhagic stroke (OR, 0.81; 95% CI, 0.76-0.86) and TIA (OR, 0.68; 95% CI, 0.64-0.73) had lower odds of receiving cessation medications than ischemic stroke patients. Cardiovascular disease burden was not associated with cessation medication provision (OR, 0.98; 95 CI, 0.94-1.02). However, multivariable models revealed demographic differences. Black (OR, 0.78; 95% CI, 0.74-0.82) and Asian (OR, 0.72; 95% CI, 0.58-0.87) patients had lower odds of receiving cessation medication, compared to White patients. Hispanic ethnicity was also associated with lower odds of cessation medication provision (OR, 0.65; 95% CI, 0.56-0.73). Conclusions: Approximately 30% of smokers were provided a smoking cessation medication during hospitalization. Compared to ischemic stroke, TIA and hemorrhagic stroke were associated with lower rates of smoking cessation medication provision, and racial and ethnic disparities were identified.

A Systematic Review on Effectiveness of Nicotine-Based and Non-Nicotine Based Drug Delivery System for Smoking Cessation Among the Elderly

Introduction: Smoking is associated with a higher risk of mortality, especially in smokers with cardiovascular and respiratory diseases. Smoking cessation remains the most effective approach in reducing smoking-related illness risks at all ages. For elderly smokers, smoking cessation has been proved to prolong life expectancy and reduce the risk of stroke and ischemic heart disease. However, a wide selection of smoking cessation medications makes prescribing challenging, especially among elderly smokers. Inability to recommend the best treatment may reduce the smoking cessation success rate in the elderly. Therefore, this study compares the effectiveness of pharmacotherapy available and correlate the effect of ageing on the effectiveness, leading to the recommendation of the best medication for elderly smokers. Method: A systematic searching strategy was performed in three different databases by using predetermined search strings. Results: Overall, this systematic review revealed that varenicline showed the greatest smoking cessation rate among the elderly, followed by bupropion and NRT. Conclusion: It is suggested that varenicline offered the best medical aid for smoking cessation in the elderly.

Varenicline induced auditory hallucinations in a young female with bipolar disorder: a case report

BackgroundCreating appropriate and sustainable treatment plans for patients with concurrent disorders presents a challenge to psychiatrists and addiction medicine specialists alike. Although varenicline has been found to be the most effective medication for smoking cessation and abstinence when compared to results from placebo medications, nicotine patches and bupropion, caution is needed when starting patients on this medication. With the high prevalence of concurrent mental health and substance use disorders in vulnerably-housed populations in Canada, it becomes increasingly important to advocate for increased guidance and research into treating concurrent disorders.Case presentationIn this case, a young female patient provisionally diagnosed with bipolar I disorder was hospitalized for a manic episode in the context of substance use and medication noncompliance. She also endorsed a long history of tobacco, alcohol, cocaine, cannabis and ketamine use. Perceptual abnormalities, including auditory hallucinations, were not recorded at admission. In addition to being stabilized for bipolar diagnosis, the patient was started on nicotine replacement therapy on Day 7 of admission followed by initiation of varenicline for smoking cessation on Day 14 of admission. Soon after the varenicline treatment was started, the patient developed auditory hallucinations, paranoia and referential beliefs. However, her insight was intact, and she had minimal thought form disorganization. In this case, these symptoms were thought to be secondary to varenicline after the consideration of potential alternative contributors.ConclusionThe occurrence of side effects as a result of varenicline use in patients with diagnosed mental health conditions is rare and underlying psychiatric illness is not labeled as an absolute contraindication in the prescription of varenicline. However, it is important to advocate for increased guidance and research on the treatment of substance use disorders in patients with bipolar I disorder. Patients may also benefit from increased collaboration between psychiatric and addiction services as that may allow for earlier recognition and intervention of symptoms to minimize distress.

Abstract A111: Smoking cessation and relapse among Black and White patients referred for lung cancer screening

Abstract Background: Tobacco quit rates in the adult U.S. population range from 4% to 8% annually. Lung cancer screening (LCS) provides an opportunity for discussion of smoking cessation. Outside of LCS, Blacks have been shown to make more quit attempts and have higher readiness to quit, but have lower quit rates among current smokers and higher relapse rates among former smokers. In this study, we determined quit and relapse rates after a provider referral for LCS in Black and White patients. Methods: We conducted an observational study within an integrated health system that has both a LCS program and an independent smoking cessation program. Patients, aged 55-77 years who received at least one provider referral (order) for LCS between September 2016 and April 2022 and a second order within 9-36 months, were included in this study.Smoking status was captured in LCS orders. Demographic variables, completion of a low-dose screening CT (LDSCT), smoking cessation counseling referral and medication prescription were captured from the electronic medical record. Pearson Chi-squared test and multivariable logistic regression were used to determine group differences and important predictors of tobacco quit and relapse. Results: During the study period, 6,096 patients (21% Black) received a referral to LCS and 75% of these patients completed an LDSCT between orders. Among current smokers (N=3715) the quit rate was 14% and relapse occurred in 10% of former smokers (N=2381), overall. Rates of quit (12.0% LDSCT no vs. 14.6% LDSCT yes, p=0.048) and relapse (13.7% LDSCT no vs. 9.4% LDSCT yes, p=0.006) were worse for those who did not complete the LDSCT between orders. Black patients had lower quit (11% vs. 14%, p=0.003) and higher relapse (13.6% vs. 9.7%, p=0.03) rates than Whites. Among Black former smokers who did not complete the LDSCT, the relapse rate was nearly 20% and these patients received referrals to counseling and prescriptions for cessation medications at higher rates than White former smokers. In multivariable models, older age, receiving a prescription for a cessation medication, and completing the LDSCT were associated with smoking cessation, while Black race and receiving a referral for counseling were associated with lower odds of quitting. Black race and longer duration between orders were associated with greater likelihood of relapse, while older age and completing the LDSCT were associated with lower likelihood of relapse. Discussion: Rates of smoking cessation appear higher in patients referred for LCS than in the general population. In the context of LCS, Black patients still have lower quit and higher relapse rates than White patients. Relapse is particularly high in Black former smokers who do not complete LDSCT after a referral for screening. Lung screening and smoking cessation programs will need to work together to find culturally appropriate resources and ways to reach out to patients referred for screening, especially those who do not complete the LDSCT, to encourage quitting and provide equitable cessation support. Citation Format: Christine Neslund-Dudas, Amy Tang, Katie Zarins, Elizabeth Alleman, Amanda Holm, Vritti Gupta, Michael Simoff. Smoking cessation and relapse among Black and White patients referred for lung cancer screening [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A111.

Effective Timing of Introducing an Inpatient Smoking Cessation Program to Cancer Patients.

We aimed to identify factors influencing smoking cessation success among cancer patients registered in an inpatient smoking cessation program at a single cancer center. The electronic medical records of enrolled patients with solid cancer were retrospectively reviewed. We evaluated factors associated with 6-month smoking cessation. A total of 458 patients with cancer were included in this study. Their mean age was 62.9±10.3 years, and 56.3% of the participants had lung cancer. 193 (42.1%) had not yet begun their main treatment. The mean number of counseling sessions for the participants was 8.4±3.5, and 46 (10.0%) patients were prescribed smoking cessation medications. The 6-month smoking cessation success rate was 48.0%. Multivariate analysis showed that younger age (<65 years), cohabited status, early stage, and the number of counseling sessions were statistically significant factors affecting 6-month smoking cessation success (p<0.05). Initiation of a cessation program before cancer treatment was significantly associated with cessation success (odds ratio, 1.66; 95% confidence interval, 1.02-2.70; p=0.040). Smoking cessation intervention must be considered when establishing a treatment plan immediately after a cancer diagnosis among smokers.

Smoking Cessation Management for Lung Cancer Smokers: An Essential Component of Treatment

In 2020 lung cancer has been the leading cause of cancer death, with an estimated 1.8 million deaths; in other words of 18% of cancer deaths. Tobacco smoking is cause of 90% of lung cancers. Despite advances in lung cancer treatment, tobacco control is the most effective measure for curbing the lung cancer epidemic. Smoking cessation, at all stages of the cancer process, is associated with benefits in terms of cure, increased life expectancy and quality of life for patients, reduced medical and surgical complications, as well as it reduces risks of recurrence or of a second primary cancer. Smoking cessation medications combined with psychological support facilitate to quit smoking. Smoking cessation management is an essential component of lung cancer treatment. Researches into the best modalities to manage smoking cessation in lung cancer patients must be conducted. Nevertheless, healthcare professionals involved in the care of cancer patients must be trained to provide personalized assistance to help smokers stopping smoking.

Cocreation of a conversational agent to help patients adhere to their varenicline treatment: A study protocol.

Varenicline is the most efficacious approved smoking cessation medication, making it one of the most cost-effective clinical interventions for reducing tobacco-related morbidity and mortality. Adhering to varenicline is strongly associated with smoking cessation. Healthbots have the potential to help people adhere to their medications by scaling up evidence-based behavioral interventions. In this protocol, we outline how we will follow the UK's Medical Research Council's guidance to codesign a theory-informed, evidence-based, and patient-centered healthbot to help people adhere to varenicline. The study will utilize the Discover, Design and Build, and Test framework and will include three phases: (a) a rapid review and interviews with 20 patients and 20 healthcare providers to understand barriers and facilitators to varenicline adherence (Discover phase); (b) Wizard of Oz test to design the healthbot and get a sense of the questions that chatbot has to be able to answer (Design phase); and (c) building, training, and beta-testing the healthbot (Building and Testing phases) where the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability framework will be used to develop the healthbot using the simplest sensible solution, and 20 participants will beta test the healthbot. We will use the Capability, Opportunity, Motivation-Behavior (COM-B) model of behavior change and its associated framework, the Theoretical Domains Framework, to organize the findings. The present approach will enable us to systematically identify the most appropriate features for the healthbot based on a well-established behavioral theory, the latest scientific evidence, and end users' and healthcare providers' knowledge.

Pharmacological approach to smoking cessation and effective intervention models

One of the main public health issues is tobacco use, which is also associated with considerate morbidity and mortality worldwide. Smoking cessation lowers mortality and risk of future cardiovascular events. Smoking is a true chronic condition that is defined by the emergence of a dependency state that is primarily caused by nicotine. Smokers are typically unable to quit smoking on their own. There are numerous approaches to treating smoking addiction, including both non-pharmacological such as behavioural counselling and pharmacological therapy. The effectiveness and safety of smoking cessation medications in everyday life are currently widely acknowledged. The primary pharmacological methods for quitting smoking include nicotine replacement therapy, varenicline, bupropion, and cytisine. Even in patients with chronic cardiovascular disease, their effectiveness and safety have been demonstrated. It has been demonstrated that nicotine replacement therapy, bupropion, varenicline, and cytisine increase the likelihood of cessation. Both varenicline and nicotine replacement therapy in combination are powerful tools for cessation. The likelihood of quitting is likewise increased by nortriptyline. Research suggests that none of the treatments seem to have a frequency of adverse reactions that would limit their usage. The clinician should tailor the smoking cessation strategy based on the most recent scientific data and the patient's preferences, giving particular attention to those patients who have certain cardiovascular and psychiatric comorbidities. The purpose of this research is to review the available information about pharmacological approach to smoking cessation and effective intervention models.

Türkiye’de sigara bırakma polikliniklerinin erişilebilirliği: İstanbul’da sigara içen bir popülasyon arasında tanımlayıcı bir çalışma

Objective: In 2011, Turkey started the nationwide “Smoking Cessation Treatment Support Program” via Smoking Cessation Clinics (SCC). This study examined the accessibility of these clinics using Levesque’s framework of access to healthcare services. From the (potential) users’ perspectives, it was aimed to find the challenges they face in accessing these clinics, and it proposed solutions for better implementation.Methods: This study was conducted among 304 smokers who visited four Family Health Centers in a geographically defined area in Istanbul, Turkey, in 2018. Result: In this study, it was found that 74% of smokers wished to quit smoking. Within them, 21% didn’t know of SCCs, and half of them didn’t know what services were provided there. Among those who knew of SCCs, 30% used them to quit smoking. The majority (75.7%) of the SCC users found the medications expensive; 41% didn’t use them, and 64% didn’t re-visit the clinics for follow-ups. Eventually, 4.3% of smokers quit smoking through SCCs. Utilization of these clinics were significantly higher among women (35%) than men (18.6%) (p=0.024). T; and there was no other differences in terms of age, marital status, income, and education level.Conclusion: Smoking cessation programs in Turkey and other countries can be implemented more efficiently if the sufficient number of clinics are opened and are accessible at the local level; more health professionals are trained to practice; the clinics are made more visible; smoking cessation medications are made available constantly; and closer monitoring of service users is ensured.

Smoking Cessation Medication Prescribing for Smokers With and Without Mental Illness.

This study examined trends in receipt of smoking cessation medications among smokers with and without mental illness, including serious mental illness, from 2005 to 2019 and characterized physician attitudes and practices related to tobacco screening and cessation treatment. Medical Expenditure Panel Survey (MEPS) data (2005-2019) were examined for receipt of cessation medication prescriptions for bupropion, varenicline, and nicotine replacement therapy (NRT) among 55,662 smokers-18,353 with any mental illness and 7,421 with serious mental illness. Qualitative interviews with 40 general internists and psychiatrists between October and November 2017 used a semistructured guide. MEPS data were analyzed with descriptive statistics, and interviews were analyzed with hybrid inductive-deductive coding. From 2005 to 2019, at least 83% of smokers with or without mental illness did not receive varenicline, NRT, or bupropion. Over 14 years, the proportion of smokers receiving varenicline peaked at 2.1% among those with no mental illness, 2.9% among those with any mental illness, and 2.4% among those with serious mental illness. The respective peak proportions for NRT were 0.4%, 1.1%, and 1.6%; for bupropion, they were 1.2%, 8.4%, and 16.7%. Qualitative themes were consistent across general internists and psychiatrists; providers viewed cessation treatment as challenging because of the perception of smoking as a coping mechanism and agreed on barriers to treatment, including lack of insurance coverage and contraindications for people with mental illness. System- and provider-level strategies to support evidence-based smoking cessation treatment for people with and without mental illness are needed.