Smoking Treatment Research Articles

Effect of Cytisine vs Varenicline on Smoking Cessation

Cytisine is more effective than placebo and nicotine replacement therapy for smoking cessation. However, cytisine has not been tested against the most effective smoking cessation medication, varenicline, which is associated with adverse events known to lead to discontinuation of therapy. To examine whether standard cytisine treatment (25 days) was at least as effective as standard varenicline treatment (84 days) for smoking cessation. This noninferiority, open-label randomized clinical trial with allocation concealment and blinded outcome assessment was undertaken in Australia from November 2017 through May 2019; follow-up was completed in January 2020. A total of 1452 Australian adult daily smokers willing to make a quit attempt were included. Data collection was conducted primarily by computer-assisted telephone interview, but there was an in-person visit to validate the primary outcome. Treatments were provided in accordance with the manufacturers' recommended dosage: cytisine (n = 725), 1.5-mg capsules taken 6 times daily initially then gradually reduced over the 25-day course; varenicline (n = 727), 0.5-mg tablets titrated to 1 mg twice daily for 84 days (12 weeks). All participants were offered referral to standard telephone behavioral support. The primary outcome was 6-month continuous abstinence verified using a carbon monoxide breath test at 7-month follow-up. The noninferiority margin was set at 5% and the 1-sided significance threshold was set at .025. Among 1452 participants who were randomized (mean [SD] age, 42.9 [12.7] years; 742 [51.1%] women), 1108 (76.3%) completed the trial. Verified 6-month continuous abstinence rates were 11.7% for the cytisine group and 13.3% for the varenicline group (risk difference, -1.62% [1-sided 97.5% CI, -5.02% to ∞]; P = .03 for noninferiority). Self-reported adverse events occurred less frequently in the cytisine group (997 events among 482 participants) compared with the varenicline group (1206 events among 510 participants) and the incident rate ratio was 0.88 (95% CI, 0.81 to 0.95; P = .002). Among daily smokers willing to quit, cytisine treatment for 25 days, compared with varenicline treatment for 84 days, failed to demonstrate noninferiority regarding smoking cessation. anzctr.org.au Identifier: ACTRN12616001654448.

IMPORTANT ASPECTS OF EFFECTIVE TREATMENT OF NICOTINE DEPENDENCE IN PATIENTS WITH DIABETES MELLITUS

Purpose. Increasing the importance and effectiveness of nicotine addiction treatment in patients with diabetes mellitus. Materials and methods . A study of nicotine addiction in patients with type II diabetes mellitus was carried out on the basis of the Department of Endocrinology of the Samara State Medical University Clinics in 2019. The psychological study included 60 men aged 45-60 who are undergoing planned treatment in the endocrinology department for type II diabetes mellitus. Psychological research included: conversation, study of the type of attitude towards illness (TOBOL), study of adherence to treatment (Moriska – Green Compliance Scale). Work with tobacco dependence was carried out according to the WHO recommendations according to the “5 A” principle [14]. Work with patients was carried out in the key of rational, behavioral and gestalt therapy. Results and discussion . In total, 24 group meetings were held – 12 group meetings in each polyclinic group of 26 people. The results obtained showed a decrease in the number of patients with a low level of physical wellbeing, psychological well-being, optimism, self-confidence, and readiness to quit smoking. Along with this, there was an increase in the number of patients with a high level of physical well-being, psychological well-being, optimism), readiness to quit smoking. As for compliance, the overall picture has also improved: there were 39 highly adherent patients among the studied (an increase from 10 % to 75 %), moderately adherent – 13 (a decrease from 73.3 % to 25 %), weakly adherent no (there were 16.7 %). Conclusions . Psychological support of nicotine-dependent patients with diabetes mellitus must necessarily include educational work with patients, work with increasing the level of self-control of the disease and adherence to treatment, with a psychoemotional state. It is optimal to include patients with diabetes mellitus in the group psychotherapeutic process in order to provide mutual assistance and receive effective support in the treatment of tobacco smoking and raise the consciousness of patients in relation to the prevention of complications of diabetes mellitus, and to the disease itself in general.

Behavioral Economic Assessment of Alcohol and Cigarette Demand in Smokers With Alcohol Use Disorder.

Background and Objectives: Behavioral economic purchase tasks are widely used to assess drug demand in substance use disorder research. Comorbid alcohol use is common among cigarette smokers and associated with greater difficulty in quitting smoking. However, demand for alcohol and cigarettes in this population has not been fully characterized. The present study addressed this gap by examining alcohol and cigarette demand among treatment-seeking smokers with alcohol use disorder (AUD).Methods: Alcohol and cigarette demand was assessed among 99 smokers with AUD. We conducted Principal Component Analysis (PCA) and correlational analyses on the demand indices.Results: Participants showed higher demand for alcohol than for cigarettes, as evidenced lower elasticity (resistance to increasing price) and higher Omax (maximum response output for drug). PCA revealed a two-factor structure (Persistence and Amplitude) for both alcohol and cigarette demand indices. Cigarette-related demand indices were positively correlated with nicotine dependence, but alcohol-related demand indices were not associated with alcohol dependence, suggesting dissociation between alcohol demand and use behaviors.Discussion and Conclusions: Our results suggest that smokers with AUD were more resistant to price elevations in relation to reducing alcohol consumption as compared to cigarette consumption, suggesting preferential demand for alcohol over cigarettes. However, it is unclear how acute substance exposure/withdrawal impacts the demand indices.Scientific Significance: Potentially differential alcohol and cigarette demands among smokers with AUD should be considered in the concurrent treatment of smoking and alcohol.

Consensus document on asthma and smoking of the Regional Asthma Forum of SEPAR.

The prevalence of active smoking in adults with asthma is similar in the total population. Smoking is associated with worse clinical control of the disease, a rapid reduction of lung function and a variable response to corticoids. Tobacco consumption negatively affects the quality of life of asthmatic patients as well as increasing the number of medical visits and hospital admissions due to exacerbations. Moreover, smoking entails a higher risk of developing lung cancer, cardiovascular comorbidities and death in asthmatic patients. Nevertheless, current asthma guidelines do not include specific recommendations on the management of smoking asthmatic patients and the treatment of the smoking habit in this subpopulation. For this reason, a narrative review of the literature was carried out for consensus using a nominal group methodology developed throughout 2019 to extract practical recommendations that would allow the diagnosis and treatment of asthma in smokers, as well as the treatment of smoking in asthmatics, to be improved. The conclusions and recommendations were validated at the SEPAR national congress of the same year. Among the most relevant, the need to address smoking in people with asthma through health advice, pharmacological treatment and behavioral therapy was emphasized, as this is a factor that negatively impacts the symptoms, prognosis and response to asthma treatment. In smokers with suspected asthma, the presence of emphysema and the differential diagnosis of other diseases should be evaluated and the impact of smoking on the result of diagnostic tests should be considered. It is also concluded that smoking reduces the response to treatment with inhaled corticosteroids, which is why combined therapy with bronchodilators is recommended.

Patterns and predictors of smoking relapse among inpatient smoking intervention participants: a 1-year follow-up study in Korea.

OBJECTIVESThis study aimed to identify relapse patterns in smokers who participated in an inpatient treatment program and to investigate factors related to relapse.METHODSThe participants comprised 463 smokers who participated in an inpatient treatment operated by the Daejeon Tobacco Control Center from 2015 to 2018. Participants received high-intensity smoking cessation intervention for 5 consecutive days, including pharmacotherapy and behavioral support, and continued with follow-up for 1 year to determine whether they maintained smoking cessation after discharge from inpatient treatment. Kaplan-Meier and Cox proportional hazard models were used in the analysis.RESULTSParticipants’ relapse rate within 1 year was 72.8%, and 59.8% of participants smoked again within 6 months after participation. A higher number of counseling sessions was significantly associated with a lower risk of relapse (hazard ratio [HR], 0.23; 95% confidence interval [CI], 0.17 to 0.32 for ≥9 vs. ≤5 counseling sessions). Conversely, higher relapse rates were significantly associated with the use of nicotine replacement therapy (NRT) (HR, 1.91; 95% CI, 1.43 to 2.55 for use vs. no use), and higher levels of baseline expired carbon monoxide (CO) (HR, 1.58; 95% CI, 1.21 to 2.06 for expired CO concentrations of 10-19 ppm vs. expired CO concentrations <10 ppm).CONCLUSIONSHigh-intensity smoking cessation interventions in hospital settings can be effective for smoking cessation in smokers with high nicotine dependence. In addition, the results suggest that for quitters to maintain long-term abstinence, they should receive regular follow-up counseling for 1 year after completing a high-intensity smoking cessation intervention.

Vedolizumab in Ulcerative Colitis and Crohn’s Disease-A Systematic Review

Background: Vedolizumab is a fully humanized monoclonal IgG-1 antibody that selectively inhibits the interaction between α4β7 integrin and mucosal addressin cell adhesion molecule-1 (MAdCAM-1). It prevents lymphocyte translocation from the blood into the inflamed gut tissue, resulting in a reduction in local inflammation. Ulcerative colitis (UC) and Crohn’s disease (CD) are inflammatory conditions of the bowel affecting approximately 1.4 million people in the US. The efficacy of the drug was studied. Methods: The outcome measures for Phase 3 and randomized clinical trials in ulcerative colitis and Crohn’s disease, was as per GEMINI 1, 2, and 3 for its efficacy. Results: A total of 309 out of 499 reported vedolizumab AEs. In comparison with all other drugs, 3PRR signals were detected including joint-related symptoms like arthralgia, upper respiratory tract infections like nasopharyngitis and sinusitis, and upper respiratory tract symptoms like oropharyngeal pain. Among the vedolizumab-associated reports with serious outcomes, the drug was used for CD in 52.5% and UC in 27.4% compared with 86.1% and 13.9% for the anti-TNFs-associated reports. Although safety data from both these studies suggest VDZ is safe, larger studies with longer follow-up will be necessary to determine the potential risk for the development of PML. Conclusion: There is limited information on other potential confounders, such as co-morbidities, duration, and severity of disease, disease phenotype, surgical history, smoking, and concurrent IBD treatment. The benefit and risk profile of combining Vedolizumab with anti-TNF-α agents in the treatment of IBD will need to be examined. Vedolizumab is revolutionary in the community of inflammatory bowel disease, especially with the potential advantage for VDZ’s selectivity to the gastrointestinal immune system. Vedolizumab provides an alternate class to biologic therapy with an encouraging response and safety profile.

Purposeful play: exploring a bar-based, anti-tobacco intervention for young adults

Social smoking is increasingly prevalent among young Americans and often takes place in nightlife social settings. Yet, few smoking interventions are embedded in these settings. This paper focuses on space, embodiment, and practice to explore young adults’ experiences of COMMUNE, a bar-based anti-tobacco intervention for ‘Hipster’ young adults; a group with shared aesthetics and interests, and high smoking rates. We conducted in-depth interviews (n = 21) with young adults involved with COMMUNE (event organizers, artists/brand ambassadors, event attendees) and observed two COMMUNE events. We analyzed the data thematically and identified three prominent affective registers: (1) ‘Fun and flow’—Messaging did not disrupt essential elements of nightlife assemblages; (2) ‘Openness and receptivity’—Playful bar settings encouraged openness and receptivity, allowing event attendees to learn about COMMUNE without feeling taught or patronized; and (3) ‘Belonging and purpose’—Events focused on an external adversary (Big Tobacco) rather than individual smoking behavior and offered a role in supporting community. This anti-tobacco intervention leveraged the capacity-enhancing elements of nightlife settings where social smoking often takes place and emphasized access to a desired experience rather than the loss of smoking. More playful, capacity-enhancing approaches can engage with smoking and other health-related behaviors. Highlights Young adult social smoking is often practiced in nightlife settings Few smoking interventions are embedded in nightlife settings We explored young adults’ experiences of a bar-based, anti-tobacco intervention Fun, flow, openness, receptivity, belonging, and purpose were prominent Smoking interventions can offer playful, capacity-enhancing experiences

A preliminary study on the application of Behavioral Activation in the treatment of smoking in women

The present study evaluated the effectiveness of Behavioral Activation (BA) on women smokers with depression and anxiety symptoms who received multi-component treatment for smoking cessation. Forty-nine women were randomly assigned to two groups. 1) experimental: BA and varenicline and 2) control, cognitive behavioral therapy for smoking cessation and varenicline.Both treatments were applied in 10 twice-weekly. The Beck Depression Inventory II, the Beck Anxiety Inventory, the Fasgeström Test, Smokerlyzer® piCO monitor for carbon monoxide breath tests, and the Behavioral Activation Scale for Depression were used. Project-by-Project Analysis (PPA) was carried out with bivariate logistic regression, including only those who had completed the treatment and follow-ups. In the second, Intention-to-Treat Analysis (ITA) used the Kaplan-Meier non-parametric method and the Log Rank Test for all those initially randomized. The results showed that the abstinence rate with the BA treatment was higher than for the cognitive behavioral treatment for smoking cessation. Furthermore, BA loss was lower than with the standard treatment. We therefore conclude that BA + varenicline was effective from the end of the smoking cessation treatment to the six-month follow-up.

Evaluation of tobacco use and willingness to accept nicotine replacement therapy during stay in an acute inpatient psychiatric ward

AimsTo evaluate tobacco smoking and willingness to try and to accept prescription of nicotine replacement therapy during psychiatric acute inpatient stay. When free to choose and use as desired (without imposing smoking cessation) patients may be open to nicotine replacement therapy.BackgroundTobacco smoking interventions are increasingly in demand especially for difficult to treat patient populations, as are those with severe mental illness. Implementing totally smoke-free psychiatric inpatient units is challenging. Imposing smoking cessation and use of nicotine substitutes may or not be the best of strategies for smoking reduction and cessation in the mid and long term. Allowing the patient free choice as to trying and learning to use nicotine replacement therapy with supervision may constitute a more acceptable approach.MethodFrom 1/1/2020 to 28/1/2020 (four weeks), 40 of the 44 patients in a general adult psychiatric inpatient unit (4 patients were too sedated or too agitated to be evaluated), with smoking restricted to a designated area and only during the day, were briefly evaluated as to their tobacco smoking habits (cigarettes/day) and willingness to accept nicotine lozenges and patches and were invited to participate in a smoking cessation programme during or after discharge.ResultOf the 40 patients evaluated, 26 were male and 14 were female, average age was 34 years (age range from 19 to 79 years). Diagnostic hypotheses for patients at admission were: schizophrenic disorder/schizoaffective disorder 9, bipolar disorder 7, psychosis not otherwise specified 19, depressive disorder 1 and other 4. 20(50%) were current smokers and 20 (50%) were non or ex-smokers. The smokers reported smoking an average of 14 cigarettes/day. Only one patient refused to try nicotine lozenges and all other smokers accepted regular prescription of nicotine lozenges during inpatient stay. 5 patients (25% of smokers) asked for or accepted suggestion to try nicotine patches in combination therapy with nicotine lozenges with the goal of smoking cessation.ConclusionPatients were open to a brief informal intervention targeting smoking behaviours and readily accepted trying nicotine lozenges and prescription during their inpatient stay. The regular use of nicotine replacement therapy by some patients encouraged other patients to try and accept therapy. In addition to the habitual tobacco sharing among patients, nicotine lozenges were also shared especially with newly admitted patients. The evaluation of the impact of this intervention will require a much longer period of time of implementation.

Risk Factors for New Vertebral Fracture After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures.

PurposeTo analyze the risk factors for new vertebral fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs).Patients and MethodsWe retrospectively reviewed the records of patients with symptomatic OVCFs who underwent PVP in our hospital, from January 2014 to January 2019. Demographic and lifestyle data on the presence of underlying chronic disease, preoperative bone mineral density, details of vertebral fractures, postoperative osteoporosis treatment, and new fracture development were collected. Patients were divided into postoperative fracture and non-fracture groups. To identify the independent risk factors for new vertebral fracture development, variables significant on univariate analysis were included in a multivariate regression model.ResultsOf the 2202 patients treated with PVP, 362 (16.43%) had a new postoperative vertebral fracture. All patients were followed up for >12 months (mean 14.7 months). Univariate analysis revealed no significant difference in height; body weight; preoperative bone mineral density; number of fractured vertebrae; injection volume of bone cement in a single vertebra; leakage rate of bone cement; or presence of hypertension, coronary heart disease, and chronic obstructive pulmonary disease between the fracture and non-fracture groups (P>0.05). Age, sex, smoking, alcohol consumption, diabetes mellitus, postoperative exercise, and postoperative osteoporosis treatment were associated with new vertebral fractures (all P<0.05). A multivariate analysis showed that age (odds ratio [OR]=1.212, P<0.0001), female sex (OR=1.917, P<0.0001), smoking (OR=1.538, P=0.026), and diabetes (OR=1.915, P<0.0001) were positively correlated with new vertebral fracture development, whereas postoperative exercise (OR=0.220, P<0.0001) and osteoporosis treatment (OR=0.413, P<0.0001) were negatively correlated.ConclusionElderly patients, females, and those with a history of smoking and diabetes are at high risk of new vertebral fracture after PVP. Patients should be encouraged to stop smoking and consuming alcohol, control blood glucose level, participate in sufficient physical activity, and adhere to osteoporosis treatment to prevent new vertebral fractures.

Risk factors for drug-resistant tuberculosis, the association between comorbidity status and drug-resistant patterns: a retrospective study of previously treated pulmonary tuberculosis in Shandong, China, during 2004–2019

ObjectiveThis study was designed to identify the risk factors for drug-resistant tuberculosis (DR-TB) and the association between comorbidity and drug resistance among retreated pulmonary tuberculosis (PTB).DesignA retrospective study was conducted...

Smoking Treatment: A Report Card on Progress and Challenges.

The impact of tobacco smoking treatment is determined by its reach into the smoking population and the effectiveness of its interventions. This review evaluates the reach and effectiveness of pharmacotherapy and psychosocial interventions for smoking. Historically, the reach of smoking treatment has been low, and therefore its impact has been limited, but new reach strategies such as digital interventions and health care system changes offer great promise. Pharmacotherapy tends to be more effective than psychosocial intervention when used clinically, and newer pharmacotherapy strategies hold great promise of further enhancing effectiveness. However, new approaches are needed to advance psychosocial interventions; progress has stagnated because research and dissemination efforts have focused too narrowly on skill training despite evidence that its core content may be inconsequential and the fact that its mechanisms are either unknown or inconsistent with supporting theory. Identifying effective psychosocial content and its mechanisms of action could greatly enhance the effectiveness of counseling, digital, and web interventions.

Evaluation of an integrated treatment to address smoking cessation and anxiety/depressive symptoms among people living with HIV: Study protocol for a randomized controlled trial

BackgroundInterventions that target anxiety/depressive symptoms in the context of smoking treatment have shown promise irrespective of psychiatric diagnosis. Yet, these tailored treatments are largely absent for persons who smoke and are living with HIV (SLWH). ObjectiveTo evaluate a novel, smoking cessation intervention that addresses anxiety/depression and HIV-related health (QUIT) against a time-matched control (TMC) and a standard of care (SOC) condition. MethodsSLWH (N = 180) will be recruited and enrolled from 3 medical clinics in Boston, MA, and Houston, TX. The trial will consist of a baseline assessment, a 10-week intervention/assessment period, and follow-up assessments, accounting for a total study duration of approximately 8 months. All participants will complete a baseline visit and a pre-randomization standardized psychoeducation visit, and will then be randomized to one of three conditions: QUIT, TMC, or SOC. QUIT and TMC will consist of nine 60-min, cognitive behavioral therapy-based, individual weekly counseling sessions using standard smoking cessation counseling; additionally, QUIT will target anxiety and depressive symptoms by addressing underlying mechanisms related to mood and quit difficulty. SOC participants will complete weekly self-report surveys for nine weeks. All participants will be encouraged to quit at Session 7 and will be offered nicotine replacement therapy to help. ConclusionsQUIT is designed to improve smoking cessation in SLWH by addressing anxiety and depression and HIV-related health issues. If successful, the QUIT intervention would be ready for implementation and dissemination into “real-world” behavioral health and social service settings consistent with the four objectives outlined in NIDA's Strategic Plan.

A Telephone-Based Tobacco Cessation Program in the State of Qatar: Protocol of a Feasibility Study.

In Qatar, tobacco is the leading preventable cause of death and disease. Telephone-based interventions for smoking are cost-effective and scalable interventions that are effective in promoting smoking behavior change. While many countries have implemented these services within their tobacco control programs, there is a distinct dearth of a telephone-based smoking cessation intervention that is adapted and tailored to meet the needs of people who smoke in Qatar. This study presents the protocol of a primary health care center integrated smoking quitline program in Qatar. Participants will be recruited from seven smoking clinics (recruitment sites). Trained clinic staff will provide brief advice on quitting followed by a referral to the quitline. Eligible participants (male smokers over 18 years of age) will complete baseline questionnaires and receive five weekly proactive counseling calls, an end-of-treatment assessment (approx. 1 week after Session 5), and 1- and 3-month follow-up assessments. The main aim of this study is to assess the feasibility and acceptability, which include the recruitment and retention rate, compliance to pharmacotherapy, and participant satisfaction. This is the first study to integrate an evidence-based smoking cessation intervention delivered via telephone within the healthcare system in Qatar. If effective, results can inform the development of a large-scale telephone-based program that widely reaches users of tobacco in Qatar as well as in the Middle East.

Python Package abstcal: An Open-Source Tool for Calculating Abstinence From Timeline Followback Data.

In smoking cessation clinical trials, timeline followback (TLFB) interviews are widely used to track daily cigarette consumption. However, there are no standard tools for calculating abstinence based on TLFB data. Individual research groups have to develop their own calculation tools, which is not only time- and resource-consuming but might also lead to variability in the data processing and calculation procedures. To address these issues, we developed a novel open-source Python package named abstcal to calculate abstinence using TLFB data. This package provides data verification, duplicate and outlier detection, missing-data imputation, integration of biochemical verification data, and calculation of a variety of definitions of abstinence, including continuous, point-prevalence, and prolonged abstinence. We verified the accuracy of the calculator using data derived from a clinical smoking cessation study. To improve the package's accessibility, we have made it available as a free web app. The abstcal package is a reliable abstinence calculator with open-source access, providing a shared validated online tool to the addiction research field. We expect that this open-source abstinence calculation tool will improve the rigor and reproducibility of smoking and addiction research by standardizing TLFB-based abstinence calculation. Abstinence calculation is an essential task in any smoking intervention study. However, there have not been standard open-source tools available to the researchers. This commentary describes a Python-based package called abstcal that can calculate abstinence from TLFB data, a common methodology to collect smoking consumption data in research settings. The package supports the calculation of point-prevalence, prolonged, and continuous abstinence. Importantly, the package has a web app interface that allows researchers to use the tool without any coding experience. This tool will facilitate smoking research by providing a standardized and easy-to-use abstinence calculation tool.

A Comparison of Quit Outcomes for Men and Women in a Smoking Cessation Program Offering Personalized Nicotine Replacement Therapy and Counseling in Primary Care Clinics

Women may have greater difficulty achieving long-term abstinence following a quit attempt compared to men. We sought to determine whether there were differences in treatment characteristics or outcome between female and male primary care patients enrolled in a smoking cessation program providing personalized nicotine replacement therapy (NRT) with counselling support. The sample included 27,601 Ontarians (53% female, 47% male) who enrolled in the Smoking Treatment for Ontario Patients program between 2016 and 2018. Dose, type, and duration of NRT supplied was personalized to need. Thirty-day point prevalence tobacco smoking abstinence was self-reported via online or telephone survey at 6 months post-enrollment. Both female and male participants received a median of 8 weeks of NRT. Types of NRT received were similar, with 80% of both female and male participants receiving patch and short-acting NRT. Total cumulative dose was somewhat higher for men (1373mg vs. 1265mg, p<0.001); but when calculated as dose per day, per cigarette smoked at baseline, dose was slightly higher among women (1.6mg vs. 1.5mg, p<0.001). Quit rates at 6 months were lower for women versus men (24% vs. 27%; AOR = 0.84 [95% CI = 0.78-0.90], p<0.001). There were no significant interactions between gender and dose, type or duration of NRT supplied. Women were slightly less likely to quit than men, despite receiving similar treatment. There was no evidence that women benefitted more or less from variations in dose, type or duration of NRT supply.

Examining the role of healthcare access in racial/ethnic disparities in receipt of provider-patient discussions about smoking: A latent class analysis

Using insurance as a single indicator of healthcare access in examining the association between race/ethnicity and healthcare encounter-based interventions for smoking may not be adequate. In this study, we assessed the role of healthcare access using multifactorial measures in accounting for racial/ethnic disparities in the receipt of provider-patient discussions, defined as either being asked about smoking or advised to quit smoking by providers. We identified adult current smokers from the 2015 National Health Interview Survey. We first conducted a latent class analysis (LCA) to identify the underlying patterns of healthcare access measured by 13 indicators of healthcare access and utilization. We then used a propensity score - based weighting approach to examine racial/ethnic disparities in receiving provider-patient discussions about smoking or quitting in stratified groups by the distinct healthcare access clusters. Out of the 4134 adult current smokers who visited a doctor or a healthcare provider during the past 12 months, 3265 (79.90%) participants were classified as having high healthcare access and 869 (20.10%) participants as having low healthcare access. Compared to non-Hispanic whites, Hispanics had significantly lower odds of being asked about smoking (OR 0.46, 95% CI (0.27–0.77)) and being advised to quit (OR 0.57, 95% CI (0.34–0.97)) in the low access group, but neither association was significant in the high access group. In addition to increasing health insurance coverage, reducing other healthcare access barriers for Hispanics will likely facilitate provider-patient discussion and promote tobacco cessation among Hispanic smokers.

“Ask Parents What They Want to Do” – Mothers Seeking Help with Parenting and Their Perspectives on Barriers and Potential Enablers for Help with Smoking Cessation: A Qualitative Study

PurposeTo describe parents' perceptions of opportunities and barriers to smoking cessation in early parenting and the support needed to achieve this. Design and methodsA qualitative approach, using semi-structured interviews with mothers, and inductive thematic analysis. ResultsBarriers to cessation intervention included readiness to quit, lack of knowledge, and the shame and stigma of seeking help. Mothers' perceived opportunities for support from early parenting services included approaches to effecting change, leveraging opportunities to explore smoking cessation, and tailoring interventions to family strengths, with a focus on promoting attachment. ConclusionsMothers may be struggling with parenting, but are also open to opportunities to explore smoking behaviours and intervention. Nurses and other health care professionals working in this setting may be well situated to support parents with their decisions to consider smoking cessation and avoid smoking relapse. Practice implicationsThe findings can assist nurses and other early parenting service clinicians to consider their approach to parents who continue to smoke or are at risk of smoking relapse.

Correlates of e-cigarette use among adults initiating smoking cessation treatment

BackgroundLittle is known about the correlates of e-cigarette (EC) use among adults seeking smoking cessation treatment, and it is unclear how EC use affects smoking treatment outcomes. MethodsParticipants were 649 adult smokers enrolled in smoking cessation treatment. Participants completed a baseline (pre-quit) assessment with follow-up at 4-, 12-, and 26-weeks after a scheduled combustible cigarette (CC) cessation date. EC use was described before and after the CC cessation date, and the impact of baseline EC use on CC cessation at follow-up was evaluated. ResultsAt baseline, 66.6 % of participants had ever-used ECs and 23.1 % reported past 30-day EC use. Past 30-day EC users were younger, more socioeconomically disadvantaged, more CC dependent, and less likely to report Black race compared to non-users. At the 4-, 12-, and 26-week follow-ups, 6.4 %, 7.4 %, and 8.1 % reported dual EC/CC use; and 2.7 %, 3.4 %, and 2.7 % had switched to exclusive EC use. Past 30-day EC use at baseline was not associated with CC cessation at any follow-up. However, among baseline past 30-day EC users (n = 150), using ECs ≥ once per week was associated with a lower likelihood of CC cessation at 26-week follow-up (adjusted OR 0.346, 95 % CI: 0.120, 0.997). ConclusionFindings indicated that dual users of CCs and ECs at baseline differed from CC-only users on sociodemographic and smoking characteristics. Baseline EC use did not impact smoking cessation overall. However, among past 30-day users, more frequent EC use at baseline adversely impacted longer-term cessation outcomes, perhaps due to greater baseline CC/nicotine dependence.

Socio-economic differences in smoking among adolescents in a school-based smoking intervention: The X:IT II study.

Aims: Socio-economic inequalities in health behaviour may be influenced by health interventions. We examined whether the X:IT II intervention, aiming at preventing smoking in adolescence, was equally effective among students from different occupational social classes (OSC). Methods: We used data from the multi-component school-based smoking preventive intervention X:IT II, targeting 13- to 15-year-olds in Denmark. The intervention was tested in 46 schools with 2307 eligible students at baseline (response rate=86.6%) and had three main intervention components: smoke-free school time, smoke-free curriculum and parental involvement. We used a difference-in-difference design and estimated the change in current smoking after the first year of implementation in high versus low OSC. Analyses were based on available cases (N=1190) and imputation of missing data at follow-up (N=1967). Results: We found that 1% of the students from high OSC and 4.9% from low OSC were smokers at baseline (imputed data), and 8.2% of the students from high OSC and 12.2% from low OSC were smokers at follow-up. Difference-in-difference estimates were close to zero, indicating no differential trajectory. Conclusions: As intended, the X:IT II intervention, designed to apply equally to students from all socio-economic groups, did not seem to create different trajectories in current smoking among adolescents in high and low socio-economic groups. To diminish social inequality in health, future studies should carefully consider the ability to affect all socio-economic groups equally, or even to appeal mainly to participants from lower socio-economic groups, as they are often the ones most in need of intervention.