Smoking Cessation Interventions Research Articles

Delivering smoking cessation interventions in NHS primary dental care - lessons from the ENHANCE-D trial

AbstractIntroduction Smoking is a major contributor to health inequalities in the UK. The ENHANCE-D trial is evaluating three smoking cessation interventions (nicotine replacement therapy [NRT], electronic cigarettes [ECs] or ‘very brief advice') delivered in NHS primary dental care. This qualitative study aimed to provide insight into the factors that could influence the adoption of the interventions in these settings.Methods Interviews were conducted at two timepoints. Purposive maximum variation sampling was used to recruit and interview a total of 24 dental patients, 12 dental professionals and three NHS dental commissioners. Thematic analysis was carried out using normalisation process theory as an analytical framework.Results Dental settings were perceived as an appropriate location to deliver smoking cessation interventions. Patients had several motivating and demotivating factors regarding use of NRTs or ECs; they often had negative preconceptions. Financial considerations were major influencers for both patients and dental teams. The time pressures for dental practices were identified as a major barrier. Some practical issues, such as procurement and stock supply, would need to be considered if the ENHANCE-D interventions were to be implemented in routine practice.Conclusion Primary dental care teams are well-placed to deliver smoking cessation interventions. However, a number of facilitators and deterrents have been identified and strategic changes are needed for successful implementation.

Examining Dyslipidemia Disparities Between Smokers and Non-Smokers: A Comparative Study

Background: Dyslipidemia, characterized by elevated total cholesterol, LDL-C, triglycerides, and low HDL-C, is a significant risk factor for cardiovascular disease. Smoking exacerbates these lipid abnormalities, increasing cardiovascular risk, yet the disparities in lipid profiles between smokers and non-smokers are not well defined.Objective: To compare the lipid profiles of smokers and non-smokers and evaluate the extent of dyslipidemia associated with smoking.Methods: A cross-sectional study was conducted with 500 participants (250 smokers, 250 non-smokers) from an urban hospital. Fasting serum samples were collected and analyzed for total cholesterol, LDL-C, HDL-C, and triglycerides. Smoking status was self-reported and validated by cotinine levels. Statistical analysis included ANOVA and multiple regression to assess lipid differences between groups, adjusting for confounders.Results: Smokers had significantly higher total cholesterol (213.4 ± 42.1 mg/dL vs. 197.2 ± 38.7 mg/dL, p < 0.001) and LDL-C (142.7 ± 35.4 mg/dL vs. 126.3 ± 31.6 mg/dL, p < 0.001) and lower HDL-C (44.3 ± 11.2 mg/dL vs. 53.7 ± 12.9 mg/dL, p < 0.001) compared to non-smokers.Conclusion: Smoking significantly worsens dyslipidemia, highlighting the need for targeted smoking cessation interventions to reduce cardiovascular risk

Resistance to anti-smoking messages related to the higher smoking stigma of Korean female smokers.

The degree of perceived smoking stigma can differ, based on various factors such as gender; this may influence the effect of smoking cessation interventions, including denormalization. This study investigates the gender differences in smoking stigma recognized by Korean smokers and explores the effect of these differences on the success of smoking cessation messages that aim to initiate an identity crisis among smokers. It aims to contribute to effective smoking cessation intervention strategies for female smokers. The smoker-gender Implicit Association Test (IAT) was used to measure gender-based smoking stigma; the test comprised photos of people smoking, with positive and negative descriptors. Participants were 120 smokers aged 19-35 years (60 males and 60 females). Participants' cognitive attitudes toward smoking and cessation intentions were assessed at baseline. To investigate the effect of social stigmatization on smokers, participants were asked to watch anti-smoking campaigns that stigmatized either smoking behavior or smokers' self-identity. Cognitive attitudes and cessations intention were used to show differences in gender and message conditions. The IAT D-score showed that female smokers perceived other female smokers significantly more negatively than they did male smokers, suggesting a higher level of smoking stigma. Female smokers in the socially stigmatizing condition reduced their negativity toward smoking less than those who were not stigmatized. Moreover, cessation intentions did not improve when female smokers received identity-threatening messages, indicating that female smokers tended to resist stigmatizing messages. These findings provide empirical evidence that the gender of Korean smokers is significantly related to differences in smoking stigma. The negative perception and resistance responses of female smokers shown in this study are consistent with the findings of previous studies on the stigma of substance use disorders and addiction. High smoking stigma can also be a risk factor in anti-smoking interventions, including health communication; therefore, these findings should be interpreted with caution.

Smoking cessation pharmacotherapy; varenicline or bupropion?

Tobacco smoking is a worldwide health problem and one of the leading causes of premature deaths in last years. As there are lots of researches focusing on cessation strategies with attention to pharmacotherapy and behavioral counseling, the aim of this study was to compare two of the first-line FDA-approved pharmacotherapies for smoking cessation; varenicline and bupropion. This writing is an overview of researches published in Pubmed database from 2012 to 2022 with "Varenicline" and "Bupropion" as key words. Among the researches that were found, 24 articles were selected which mainly focused on comparison of these two medicines. Varenicline and bupropion are known as non-nicotinic pharmacotherapy and have been used in addition to nicotine replacement therapy for smoking cessation. Varenicline is partial agonist for α4β2 nicotinic acetyl choline receptors while bupropion, classified as an atypical antidepressant, is actually a norepinephrine and dopamine reuptake inhibitor. Although these treatments can result in some adverse effects including nausea, insomnia, anxiety, irritability, fatigue and abnormal dreams, their efficacy in reduction of craving and also maintenance of abstinence is well been studied and approved by FDA. Moreover, adverse effects are usually mild to moderate clinical symptoms which can be tolerated and also easily managed and prevented in cases. The efficacy and tolerability of varenicline and bupropion as treatments for smoking cessation is well understood. However, studies have shown that varenicline seems to be more effective in maintaining of abstinence and also reducing craving than bupropion and NRT.

Learning & motivational talk in smoking cessation interventions: An examination of session language in two randomized trials

ObjectivesMotivational Interviewing (MI), a client-centered approach that seeks to evoke and resolve ambivalence, and health education (HE), which provides health information and advice, may both provide some benefit to unmotivated smokers. In HE, it is possible that client language reflective of new learning, or “learning talk” (LT), and rejection of health advice, or “rejection talk,” (RT), may uniquely reflect intent of subsequent behavior change. MethodsThis project utilized MI and HE sessions from two randomized clinical trials (RCTs), one in a low-income, diverse community civilian sample of 255 unmotivated smokers, and the other in a sample of Veterans with mental illness who were unmotivated smokers (n = 55).Mixed methods approaches were utilized to reliably code sessions using the Motivational Interviewing Skill Code 2.5 (MISC 2.5)1 and a refined Learning Talk coding system2. ResultsReliability of LT and RT codes ranged from fair to excellent (ICCs from 0.43–0.93). ConclusionLT appears to be a unique construct and its impact on post-session changes in smoking is warranted. Practice implicationsThis system can be used in a study to code existing interventions for smokers using both MI and HE techniques and relate in-session client LT to subsequent smoking behaviors.

Approach Bias and Tobacco Craving as Mechanisms of the Effect of Approach Bias Retraining on Smoking Cessation.

Approach bias, the automatic tendency to advance toward, rather than move away from appetitive cues, has been associated with greater tobacco cravings, dependence, and likelihood of smoking relapse. Approach bias retraining (ABR) has emerged as one way to reduce approach bias and promote avoidance toward smoking cues. Yet, additional research is needed to identify the mechanisms that may help explain the effect of ABR on smoking cessation. The current study uses data collected as part of a randomized controlled trial to test two unique mechanisms of action ([1] approach bias and [2] tobacco craving) for the efficacy of standard smoking cessation treatment (ST) augmented by ABR on smoking abstinence. Participants were 96 adult daily smokers (Mage=43.1, SD=10.7) motivated to quit smoking. Results showed that lower approach bias and lower cravings at a treatment session were significantly related to next session smoking abstinence (p's<.018). Further, deviations in approach bias partially mediated the effect of ABR on smoking abstinence (ab=-12.17, 95%CI: [-29.67, -0.53]). However, deviations in tobacco craving did not mediate this relation (ab=.40, 95%CI: [-.27, 1.34]). The current findings add to extant literature by identifying approach bias as a mechanism of action of the effect of ABR on smoking abstinence during smoking cessation treatment. The current study adds to our knowledge on the effectiveness of approach bias retraining (ABR) as a part of smoking cessation treatment. Results indicate that reductions in approach bias partially mediate the effect of ABR on smoking abstinence. These findings are consistent with previous research on alcohol-dependent adults and underline the potential of ABR to reduce approach bias and promote smoking cessation among smokers. Such findings could inform the development of future research exploring more targeted and effective smoking cessation interventions, ultimately improving outcomes for individuals attempting to quit smoking.

Association between Use of Combustible Cigarettes and Noncombustible Nicotine or Tobacco Products and Health-Related Quality of Life in Korean Men: A Nationwide Population-Based Study.

Although the association between smoking and health-related quality of life (HRQoL) has been established, the effects of tobacco products, including combustible cigarettes (CCs) and non-combustible nicotine or tobacco products (NNTPs), on HRQoL remain unclear. This study examined the association between tobacco use and HRQoL in Korean men. Data from the Korea National Health and Nutrition Examination Survey conducted between 2013 and 2020 were analyzed. A total of 16,429 male participants aged ≥19 years completed the European Quality of Life-5 Dimensions (EQ-5D). Impaired HRQoL was defined as scoring in the lowest 20% of the EQ-5D index and having some or extreme problems in the following five domains of the EQ-5D: mobility, self-care, usual activities, pain/ discomfort, and anxiety/depression. Multiple logistic regression was conducted to evaluate the risk of impaired HRQoL in current tobacco users. Current tobacco users exhibited a significantly higher risk of impaired HRQoL compared with never users (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.05-1.92). Compared to never users, current tobacco users reported more problems with mobility and pain/discomfort (all P<0.05). Moreover, compared with former tobacco users, current tobacco users had a higher risk of impaired HRQoL (OR, 1.60; 95% CI, 1.18-2.17). Compared to former tobacco users, current tobacco users reported more problems with mobility and pain/discomfort (all P<0.05). Use of CCs and NNTPs is associated with impaired HRQoL in Korean men. Therefore, further interventions for lifestyle modification and smoking cessation treatments are required to reduce the risk of impaired HRQoL among current tobacco users.

How do people quit smoking using e-cigarettes? A mixed-methods exploration of participant smoking pathways following receiving an opportunistic e-cigarette-based smoking cessation intervention.

Pathways of transitioning from tobacco smoking to vaping after receiving an e-cigarette-based smoking cessation intervention have been minimally explored. 1) identify pathways between intervention delivery and final follow-up; 2) describe baseline and post-intervention statistical data in relation to smoking/vaping behaviour of the different pathway groups; 3) explore qualitative participant perspectives contextualising pathway groups. Embedded mixed-methods analysis of data collected for the Cessation of Smoking Trial in the Emergency Department (COSTED) randomised controlled trial. Recruitment from 6 Emergency Departments (5 in England and 1 in Scotland) between January and August 2022. 366 adult smokers who were randomised to receive the COSTED intervention and provided data at 6-month follow-up. Qualitative subsample of 24 participants interviewed after follow-up. Brief smoking cessation advice, provision of an e-cigarette starter kit and referral to the local Stop Smoking Service. Descriptive statistical reporting of identified pathways and smoking/vaping behaviour at baseline and 6-month follow-up. Semi-structured phone/video interviews analysed thematically. 13.4% (n = 49) of participants quit smoking within 1month of receiving the intervention, 19.1% (n = 70) quit between 1 and 6months, 24.9% (n = 91) reduced cigarettes per day (CPD) by at least 50%, and 42.6% did not experience a significant smoking reduction. Approximately a third of participants who quit reported not vaping at follow-up. Reporting dual use was associated with a reduction in CPD. Appoximately athird reported experimenting with a different device to the one provided as part of the intervention. Quitters reported themes of satisfaction with vaping, changes in environment facilitating quitting and motivation to quit. Dual use of cigarettes and e-cigarettes can result in a reduction of smoking and may prelude quitting smoking. Sustained e-cigarette use is not always necessary for quitting success. Success depends on personal context as well satisfaction with vaping.

Effectiveness of mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling at outdoor smoking hotspots: A cluster randomized controlled trial.

To evaluate the effectiveness of mobile smoking cessation (SC) treatment with 1-week nicotine replacement therapy (NRT) sampling on recruitment and quitting outcomes. Two-arm cluster RCT (1:1 ratio), single-blinded, at 244 recruitment sessions in Hong Kong outdoor smoking hotspots from October 2018-December 2019. Participant were recruited by ambassadors and treated at the mobile SC truck. 834 adult (≥18 years, male 81.3%) daily smokers, Chinese-speaking, non-NRT users in the past month, consented after nurse-led intervention in mobile SC truck were randomized to the experimental (n = 482 male 79.5%) and the control group (n = 352, male 83.8%). The experimental group received a 1-week free NRT sample, an NRT instruction card, and mobile SC treatment including onsite nurse-led brief medication advice (about 15 minutes) and referral to SC clinics. The control group received the same mobile SC treatment. Primary outcome was self-reported quit attempts at 1-month follow-up. Secondary outcomes included SC service use at 1month, and biochemically validated abstinence (exhaled carbon monoxide < 4ppm; or saliva cotinine < 10ng/ml) at 6-month follow-up. Additionally, a post-hoc cost analysis was conducted. By intention-to-treat, the two groups showed similar prevalence of quit attempts (44·4% versus 43·5%, risk ratio (RR) = 1·04, 95% confidence interval (CI) = 0·79-1·37, P = 0·79). Compared with the control group, the experimental group showed lower SC service use at clinics (32·4% versus 44·9%, RR = 0·72, 95%CI = 0·57-0·91, P = 0·006), but no significant difference in validated abstinence (4·6% versus 2·8%, RR = 1·64, 95%CI = 0·76-3·50, P = 0·21). The experimental recruitment sessions recruited more smokers for onsite medication advice than the control session (mean 6·7 vs 5·0, adjusted incident rate ratio = 1·30, 95%CI = 1·08-1·56, P = 0·005). Mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling did not increase quit attempts or abstinence outcomes among recruited daily smokers in Hong Kong. The intervention increased smokers' uptake of onsite medication advice but reduced subsequent smoking cessation service use at clinics.

Aboriginal and Torres Strait Islander people who smoke and want to quit - a cohort profile from the Koori Quit Pack study.

Reducing the prevalence of smoking is a national priority, however there is limited evidence on what smoking cessation supports are utilised, accessible, and effective among Aboriginal and Torres Strait Islander people. This paper describes a cohort profile of Aboriginal and Torres Strait Islander people who smoke and want to quit to inform tailored smoking cessation interventions. Aboriginal and Torres Strait Islander people residing in New South Wales (NSW), Australian Capital Territory (ACT), and Victoria, who were smokers wanting to quit, were recruited through health services and online advertisements from May to October 2022. Descriptive and inferential statistics were used to summarise participant characteristics and explore factors associated with previous use and adherence to Nicotine Replacement Therapy (NRT) and intention to use Quitline services. 165 participants were recruited. Almost all (93.9%) had made at least one previous quit attempt, and 40.6% had used behavioural support. The majority believed NRT was safe (80.6%), effective (70.3%) and tried NRT previously (89%). Preferred forms of NRT for current quit attempts were nicotine patches (85.5%) and inhalers (69.7%). Intention to use Quitline was found to be higher among participants aged 31-45 years compared to participants under 30 years (AOR=3.12, 95%CI, 1.01-9.76). Aboriginal and Torres Strait Islander people are highly motivated to be smoke-free. However, efforts to enhance access and adherence to cessation supports are needed. The rapid recruitment and interest in the mailout cessation support should be scaled up to support Aboriginal and Torres Strait Islander peoples to quit. The Australian Government has recently launched a national tobacco strategy which includes targets for reducing smoking prevalence to less than 27% among Aboriginal and Torres Strait Islander peoples. In order to meet these targets Aboriginal and Torres Strait Islander people who smoke and want to quit should have access to culturally safe and responsive support. We found that Aboriginal and Torres Strait Islander people have made quit attempt, accessed evidence-based smoking cessation care, and have positive attitudes towards NRT. However, acknowledging relapse, further evidence is required to understand the factors associated with sustained quitting.

Theoretically framing views of people who smoke in understanding what might work to support smoking cessation in coastal communities: adapting the TIDieR checklist to qualitative analysis for complex intervention development

IntroductionPeople living in coastal communities have some of the worst health outcomes in the UK, driven in part by high smoking rates. Deprived coastal communities include socially disadvantaged groups that struggle to access traditional stop smoking services. The study aimed to seek the views of people who smoke living in coastal communities, to assess the optimal smoking cessation intervention for this population. In addition, the Template for Intervention Description Replication (TIDieR) checklist was adapted as an analytical framework for qualitative data to inform intervention design.MethodsCurrent or recent ex-smokers (n = 25) were recruited to participate in qualitative interviews from a range of community locations in a deprived English seaside town. A thematic analysis of the interview data was undertaken adapting the TIDieR framework. This analysis was triangulated with relevant literature and notes from stakeholder meetings and observations to map onto the TIDieR checklist to describe the optimal intervention.ResultsBarriers to quitting smoking in the target population included low motivation to quit, high anxiety/boredom, normalisation of smoking and widespread illicit tobacco use. There was broad support for combining behavioural support, e-cigarettes and financial incentives, with a strong preference for the intervention to be delivered opportunistically and locally within (non-healthcare) community settings, in a non-pressurising manner, ideally by a community worker specially trained to give stop smoking support.ConclusionsAn intensive community-based smoking cessation intervention was acceptable to the target population. Adapting the TIDieR checklist as a deductive qualitative analytical framework offered a systematic approach to intervention development. Combined with other intervention development activities, this ensured that the intervention design process was transparent and the proposed intervention was well defined. It is recommended that prior to intervention development researchers speak to members of the target population who may give valuable insight into the optimal intervention.

Interventions for smoking cessation in inpatient psychiatry settings.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of smoking cessation interventions on tobacco smoking in adults receiving inpatient psychiatry treatment. To assess whether the effects of smoking cessation interventions differ according to psychiatric diagnosis or type of intervention or comparator condition.

CN12 Efficacy of digital health intervention in smoking cessation: A systematic review and network meta-analysis of randomized controlled trials

CN12 Efficacy of digital health intervention in smoking cessation: A systematic review and network meta-analysis of randomized controlled trials

Financial Strain and Smoking Cessation and Relapse Among U.S. Adults Who Smoke: A Longitudinal Cohort Study

IntroductionThis study examines the prospective association between financial strain and smoking cessation and smoking relapse among US adults with established smoking. MethodsDiscrete-time survival models were fit to nationally representative data in Waves 1-5 (2013-2019) of the US Population Assessment of Tobacco and Health Study for smoking cessation (n=6,972) and smoking relapse (n=1,195). Models were adjusted for demographics (age, sex, race and ethnicity), socioeconomic positioning (education, income, health insurance status), and tobacco-related confounders (quit attempts, coupon receipt, and nicotine dependence). Data were collected between 2013 and 2019, and the analysis was conducted in 2023-2024. ResultsAmong adults with established cigarette smoking, financial strain was associated with a reduced likelihood of cigarette smoking cessation (HR: 0.81, 95% CI: 0.72, 0.92) and an increased likelihood of cigarette smoking relapse (HR: 1.56, 95% CI: 1.24, 1.96) in multivariable models. Results were robust to sensitivity analyses varying confounder control, sample restrictions, and survey weights used. ConclusionsThe results from this study suggest that financial strain is a barrier to cigarette smoking without relapse, which may be due to stress and coping processes. Smoking cessation interventions would benefit from considering the role that financial strain plays in inhibiting smoking cessation without relapse.

Feasibility of remote delivery of a smoking cessation intervention for people with severe mental illness: a telephone consultation

Background The COVID-19 pandemic meant that face-to-face delivery of a smoking cessation intervention in India and Pakistan for people with severe mental illness within a feasibility trial was not possible. Rather than halt the feasibility trial, the decision was taken to adapt the intervention for remote delivery. This paper presents a telephone consultation conducted with key stakeholders to inform this adaptation. Objective To consult with key stakeholders on the feasibility, challenges and solutions for remote delivery of a smoking cessation intervention for people with severe mental illness in India and Pakistan. Design Rapid mixed-methods telephone consultation. Setting Two mental health facilities, one in Bengaluru, India, and the other in Rawalpindi, Pakistan. Participants Thirty-two members (16 India, 16 Pakistan) of Community Advisory Panels at the mental health facilities. Members were people with severe mental illness (2 India, 8 Pakistan), caregivers (3 India, 2 Pakistan) and professionals (11 India, 6 Pakistan). Data collection and analysis Questions explored general views on remote intervention delivery and specific feedback on nine intervention components (providing information, advising, asking questions, discussion, assessing motivation, using a flipbook, recording activities in a booklet, measuring exhaled carbon monoxide and administering medication). Telephone consultations were audio-recorded. Descriptive statistics were used for quantitative data, content analysis for qualitative data and then triangulated. Results All three participant groups identified challenges and solutions. Overall remote delivery was considered feasible with a preference for telephone sessions, supplemented with video, delivered for 30 minutes in the morning. Except for measuring carbon monoxide, all components were seen to be feasible, with more positive opinions evident in India. The key challenge related to achieving effective communication over the phone, especially for people with severe mental illness or low literacy. Access (connectivity and phone ownership) and monitoring medication use were other challenges. Popular solutions were to involve caregivers in all intervention components and to ensure these components and associated resources were appropriate for this patient group including those with low literacy. Based on this valuable feedback, the smoking cessation intervention was adapted for hybrid (remote and face-to-face) delivery instead of exclusive remote delivery with significant changes made to its delivery and content. Limitations This was a rapid consultation with a small sample of stakeholders. There were missing quantitative data in Pakistan. Conclusions Key stakeholders viewed remote delivery of the smoking cessation intervention among people with severe mental illness as feasible and particularly important when face-to-face delivery is not possible. The intervention was subsequently adapted for hybrid (remote and face-to-face) delivery. Future work Evaluating the feasibility and acceptability of hybrid delivery of this smoking cessation intervention was completed. A full trial commences in July 2024. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 17/63/130.

Fine-mapping the CYP2A6 regional association with nicotine metabolism among African American smokers.

The nicotine metabolite ratio (NMR; 3'hydroxycotinine/cotinine) is a stable biomarker for CYP2A6 enzyme activity and nicotine clearance, with demonstrated clinical utility in personalizing smoking cessation treatment. Common genetic variation in the CYP2A6 region is strongly associated with NMR in smokers. Here, we investigated this regional association in more detail. We evaluated the association of CYP2A6 single-nucleotide polymorphisms (SNPs) and * alleles with NMR among African American smokers (N = 953) from two clinical trials of smoking cessation. Stepwise conditional analysis and Bayesian fine-mapping were undertaken. Putative causal variants were incorporated into an existing African ancestry-specific genetic risk score (GRS) for NMR, and the performance of the updated GRS was evaluated in both African American (n = 953) and European ancestry smokers (n = 933) from these clinical trials. Five independent associations with NMR in the CYP2A6 region were identified using stepwise conditional analysis, including the deletion variant CYP2A6*4 (beta = -0.90, p = 1.55 × 10-11). Six putative causal variants were identified using Bayesian fine-mapping (posterior probability, PP = 0.67), with the top causal configuration including CYP2A6*4, rs116670633, CYP2A6*9, rs28399451, rs8192720, and rs10853742 (PP = 0.09). Incorporating these putative causal variants into an existing ancestry-specific GRS resulted in comparable prediction of NMR within African American smokers, and improved trans-ancestry portability of the GRS to European smokers. Our findings suggest that both * alleles and SNPs underlie the association of the CYP2A6 region with NMR among African American smokers, identify a shortlist of variants that may causally influence nicotine clearance, and suggest that portability of GRSs across populations can be improved through inclusion of putative causal variants.

A systematic review of suicide among Iranians physicians, etiology and solutions

Suicide is a multifaceted public health problem that, unfortunately, remains the leading cause of death worldwide. Studies show that the rate of mental illness, particularly suicide, is higher among doctors than among the public, and the risk of depression and suicide among doctors has also increased. Interventions such as resilience and mindfulness programs can reduce suicidal thoughts among medical students. Suicide prevention programs should target high-risk groups, such as physicians. Studies have shown that medical students and physicians are at higher risk of suicide than the general population. The prevalence of mental health issues and suicidal thoughts increases during medical school. Psychological factors, such as burnout, depression, anxiety, and hopelessness, can lead to suicidal thoughts. Considering the worldwide significance of this issue and the recent increase in mortality among youthful Iranian physicians, we conducted and investigated the prevalence and possible causes of suicidal ideation among Iranian medical students and graduates in this study. The problem of suicides among Iranian doctors and the sudden increase in the deaths of doctors, especially young people, is dangerous. Suicides among Iranian medical, dental, and pharmacy students have increased in recent years. It may be beneficial to support populations at high risk for suicidal ideation and provide screening for early intervention, as well as raise awareness of the prevalence and impact of suicidal thoughts among male students, school officials, and teachers. Screening should include individuals with a family history of mental health issues and those who are separated from their parents, as these individuals are at increased risk for suicidal thoughts. Reducing the prevalence of suicidal ideation may benefit from smoking cessation interventions and stress-reducing curricula. In addition, studies show that work stress among Iranian doctors and dentists can affect their work and treatment. Controlling and managing occupational stress is vital to prevent future problems, as it can have physical and psychological consequences. High levels of occupational stress among these doctors can also pose a danger to their patients. Identifying the causes of physician suicide can help to control and manage it.

Perspectives of Hospital Staff on Barriers to Smoking Cessation Interventions among Drug-Resistant Tuberculosis Patients in a South African Management Hospital.

Drug-resistant tuberculosis (DR-TB) remains a major cause of illness and death, with personal and non-addiction-related barriers. This study aimed to explore the perspectives of hospital staff on barriers to smoking cessation interventions (SCIs) for in-patients at a DR-TB management hospital in Durban, KwaZulu-Natal, South Africa. In-depth interviews were conducted with a purposive sample of eighteen hospital staff (HS), and the data were analyzed using NVivo 10. Three core themes were identified: patients' barriers (addiction to tobacco, relapse after improvement in health, and non-disclosure of smoking status to HS), staff personal barriers (poor knowledge of smoking's effect on treatment outcomes and smoking cessation aids), and institutional barriers (staff shortage, time constraints, lack of pharmacological smoking cessation aids, access to cigarettes around hospital premises, and SCIs not prioritized and not assigned to a specific category of HS). Training on SCIs for HS, assigning SCIs to specific HS, integrating SCIs within existing services, and banning access to cigarettes within the hospital premises are assumed to assist DR-TB patients in smoking cessation, improving their response to TB treatment and overall health outcomes.

A multicomponent smoking cessation program for adults with Type 2 Diabetes Mellitus (DiMe-SALUD2 project): A study protocol of a randomized controlled trial

BackgroundTobacco use represents a significant public health burden, being especially harmful for smokers with Type 2 Diabetes Mellitus (T2DM). Effective smoking cessation interventions are required for this vulnerable population. The goal is to describe a study protocol of a randomized controlled trial (RCT) aimed at analyzing the effectiveness and efficiency of a multicomponent smoking cessation intervention for T2DM smokers, including a training protocol on healthy lifestyle habits and self-management of T2DM (DiMe-SALUD2 project). MethodsThis RCT will assign participants to: (1) Control Group (n = 30), including a brief psychoeducation advice about smoking cessation; (2) Cognitive-behavioral treatment (CBT) for smoking cessation (n = 30), based on a multicomponent program implemented in group-based sessions over an eight-week period; and (3) CBT plus DiMeSALUD2 protocol (n = 30), which will develop an additional psychoeducational protocol specifically designed to improve healthy lifestyle habits. Participants will be assessed at baseline, post-treatment and several follow-ups (1-, 6- and 12-months). Primary outcomes will include smoking abstinence (24-h point prevalence abstinence at post-treatment and 7-day point prevalence at follow-ups) and smoking continuous abstinence. Secondary outcomes will include treatment retention, changes in smoking patterns and nicotine dependence, as well as the impact on T2DM clinical variables, mental health, and quality of life. DiscussionThe DiMeSALUD2 program could assist T2DM smokers in quitting tobacco use and improving their overall quality of life. This project will help incorporating improvements in routine clinical practice with T2DM patients, offering a smoking cessation program adapted to their specific needs. Trial registrationClinicalTrials.gov. Identifier: NCT05885659. Date of registration: June 2nd, 2023.

A National Dental Practice-Based Research Network phase II, cluster-randomized clinical trial assessing nicotine replacement therapy sampling in dental settings: study protocol for the Free Samples for Health (FreSH) study

BackgroundCigarette smoking has major detrimental effects on oral health. Tobacco interventions in dental settings are effective, but rarely delivered. The American Dental Hygienists Association recommends that oral health providers: Ask patients about tobacco use, Advise quitting tobacco use, and Refer to state quitlines (Ask-Advise-Refer; AAR). While AAR connects patients to counseling, it does not directly connect patients to medication. Nicotine replacement therapy sampling (NRTS) is an empirically supported intervention to provide starter packs of nicotine replacement therapy (NRT) to people who smoke. NRTS combined with AAR could be an effective tobacco treatment intervention for dental settings.MethodsThis manuscript describes the study protocol for the Free Samples for Health (FreSH) study, a group randomized clinical trial testing the effectiveness of NRTS + AAR vs. AAR alone on long-term smoking abstinence. Fifty dental practices in the Midwest and Northeast nodes of the National Dental Practice-Based Research Network are randomly assigned to provide AAR and either a 2-week supply of 14-mg nicotine patches and 4-mg nicotine lozenges (NRTS condition) or an electric toothbrush (ET condition). Approximately 1,200 patients who currently smoke—regardless of interest in quitting— are recruited during dental visits. Participants complete a baseline survey in-person, then after visit, 1-, 3-, and 6-month follow-up surveys remotely. The primary outcome is carbon monoxide-confirmed 7-day point prevalence abstinence from combustible tobacco measured at 6 months post-enrollment. Secondary outcomes include: 24-h intentional quit attempts, change in cigarettes smoked per day, NRT utilization, attitudes toward NRT, intention to use NRT, and intention to quit smoking. A key informant process evaluation and cost effectiveness analysis will provide information for future implementation of NRTS.DiscussionThis is the first clinical trial to assess the effectiveness of NRTS on promoting smoking cessation in dental settings. If effective, this treatment could be implemented to increase the provision of smoking cessation interventions in dental settings to provide an additional treatment access point for people who smoke.Trial Registration.Registered at ClincalTrials.gov (NCT05627596) on 11/25/2022.