Specific Smoking Cessation Intervention Research Articles

Factors associated with intentions to quit tobacco use in Lebanon: A cross-sectional survey

IntroductionThe prevalence of tobacco smoking in Lebanon is among the highest globally. This study aims to determine past attempts to quit smoking among adults and identify factors associated with intentions to quit. MethodsA nationally representative telephone survey was conducted between June and August 2022. Eligibility criteria included people aged >=18 years residing in Lebanon. The questionnaire was divided into three components: socio-demographic characteristics, cigarette and waterpipe tobacco use behaviours. Binary logistic regression was used to examine factors associated with intention to quit cigarette and waterpipe tobacco use. ResultsA total of 2003 respondents were included in the study. The prevalence of any tobacco product use was 41%, the prevalence of current cigarette smoking was 41% and the prevalence of current waterpipe tobacco use was 20%. Approximately 24% of adults who smoke cigarettes and 26% of those who use waterpipe tobacco had previous quit attempts mainly due to health concerns. Intentions to quit smoking within the next 6 months were reported among 12% of survey respondents. Among adults who smoke, past quit attempts increased the likelihood of intentions to quit cigarette smoking by 5-fold (OR: 5.11; 95% CI: 1.80–14.47, p = 0.002) and waterpipe tobacco use by 7-fold (OR: 6.98, 95% CI: 2.63–18.51, p = <0.001). Age and income were associated with intentions to quit cigarette but not waterpipe tobacco use. ConclusionIntention to quit smoking was strongly associated with past quitting attempts. Understanding factors associated with intentions to quit can help inform the development of context specific smoking cessation interventions.

ES01.03 Integration of Cessation Services in Low Dose CT Screening

Lung cancer screening with low dose computed tomography (LDCT) of the chest has picked up momentum over the last decade. The publication of results from the National Lung Screening Trial (NLST) in 2011 confirmed the mortality benefit of this intervention in high-risk tobacco smokers. Nearly a decade later, this was supported by the results of the NELSON study. Subsequent analyses have showed that in these high-risk candidates, the impact of smoking cessation could be profound. In people who already have a diagnosis of lung cancer, smoking cessation can improve outcomes. This includes prolonged survival across all stages of cancer as well as a reduction in the development of second primary lesions. Data from the NLST have shown that in those candidates who stopped smoking, the risk of dying from lung cancer fell. This reduction matched the benefit of CT screening by seven years of abstinence. The mortality benefit of LDCT screening was nearly doubled in candidates who achieved fifteen years of smoking abstinence. Despite the high impact of smoking cessation, the best way to achieve this in LDCT screening candidates has not yet been established. Many studies are now investigating this, in countries that have formally instituted lung cancer screening such as the United States and in those where national screening programs remain under consideration. In the United States, eight studies form the SCALE Collaboration (Smoking Cessation within the Context of Lung Cancer Screening) across a range of sites and institutions. Strategies include digital advice, comparisons of behavioural interventions and various nicotine replacement regimens among several thousand screening candidates. In the United Kingdom, the Yorkshire Enhanced Stop Smoking (YESS) study will test the impact of personalized interventions in screening candidates, including the use of incidental CT findings and matched CT imagery. Data from previous lung cancer screening studies support the addition of specific smoking cessation intervention in eligible candidates, including the Danish Lung Cancer Screening Trial and the UK Lung Cancer Screening Trial as well as the NLST and the NELSON. Screening candidates often have high rates of motivation to quit, higher quit rates than the background smoking population and respond to CT abnormalities with greater smoking abstinence. Smoking cessation as part of LDCT screening contributes significantly to cost-effectiveness of screening programs. In general, LDCT screening guidelines strongly support smoking cessation as part of screening programs but refrain from making specific recommendations on detailed cessation interventions. As jurisdictions around the world move to introduce formal lung cancer screening, the impact of rigorous, specific smoking cessation interventions will grow. Implementation research programs that help LDCT screening candidates quit smoking represent a major opportunity to enhance screening success.

Systematic review of behavioural smoking cessation interventions for older smokers from deprived backgrounds

IntroductionThe associations between smoking prevalence, socioeconomic group and lung cancer outcomes are well established. There is currently limited evidence for how inequalities could be addressed through specific smoking cessation interventions...

Changes and Clinical Consequences of Smoking Cessation in Patients With COPD: A Prospective Analysis From the CHAIN Cohort

Despite the existing evidence-based smoking cessation interventions, chances of achieving that goal in real life are still low among patients with COPD. We sought to evaluate the clinical consequences of changes in smoking habits in a large cohort of patients with COPD. CHAIN (COPD History Assessment in Spain) is a Spanish multicenter study carried out at pulmonary clinics including active and former smokers with COPD. Smoking status was certified by clinical history and co-oximetry. Clinical presentation and disease impact were recorded via validated questionnaires, including the London Chest Activity of Daily Living (LCADL) and the Hospital Anxiety and Depression Scale (HADS). No specific smoking cessation intervention was carried out. Factors associated with and clinical consequences of smoking cessation were analyzed by multivariate regression and decision tree analyses. One thousand and eighty-one patients with COPD were included (male, 80.8%; age, 65.2 [SD 8.9] years; FEV1, 60.2 [20.5]%). During the 2-year follow-up time (visit 2, 906 patients; visit 3, 791 patients), the majority of patients maintained the same smoking habit. Decision tree analysis detected chronic expectoration as the most relevant variable to identify persistent quitters in the future, followed by an LCADL questionnaire (cutoff 9 points). Total anxiety HADS score was the most relevant clinical impact associated with giving up tobacco, followed by the LCADL questionnaire with a cutoff value of 10 points. In this real-life prospective COPD cohort with no specific antismoking intervention, the majority of patients did not change their smoking status. Our study also identifies baseline expectoration, anxiety, and dyspnea with daily activities as the major determinants of smoking status in COPD. ClinicalTrials.gov; No. NCT01122758; URL: www.clinicaltrials.gov.

Cost-effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD.

AimsTo evaluate costs, effects and cost‐effectiveness of increased reach of specific smoking cessation interventions in Germany.DesignA Markov‐based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health‐care perspective (extended to include out‐of‐pocket payments) with life‐time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates.SettingGermany.ParticipantsCohort of current smoking population (18+ years) in Germany.InterventionsInterventions included group‐based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group‐based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England.MeasurementsEQUIPTMOD considered reach, intervention cost, number of quitters, quality‐of‐life years (QALYs) gained, cost‐effectiveness and return on investment.FindingsThe highest returns through reduction in smoking‐related health‐care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group‐based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost‐savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return‐on‐investment estimates. At a hypothetical willingness‐to‐pay threshold of only €5000, the probability of being cost‐effective is approximately 75% for prospective scenario 1.ConclusionsIncreasing the reach of group‐based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost‐effective.

Culturally specific versus standard group cognitive behavioral therapy for smoking cessation among African Americans: an RCT protocol.

BackgroundAfrican American smokers experience disproportionately higher rates of tobacco-related illnesses compared to Caucasians. It has been suggested that interventions targeted to specific racial/ethnic groups (i.e., culturally specific) are needed; however, the literature examining the efficacy of culturally specific interventions is equivocal. Moreover, there are few descriptions of methods used to create these interventions. The main aim of this study is to test the efficacy of a culturally specific smoking cessation intervention among African Americans.Methods/DesignA 2-arm randomized controlled trial (RCT) will be conducted to assess the efficacy of a culturally specific group cognitive behavioral therapy (CBT), compared to standard group CBT among treatment-seeking smokers from the community. Participants in both conditions receive the transdermal nicotine patch (TNP) for 8-weeks. We intend to randomize at least 247 adult smokers who self-identify as African American into the trial. Enrolled participants are block randomized into one of two groups: Standard group CBT (control) or a culturally specific group CBT (CS-CBT). Groups are matched for time and attention, and consist of eight sessions. The primary outcome variable is 7-day point prevalence abstinence (7-day ppa). Smoking status is assessed at the end-of-counseling (EOC), and 3, 6, and 12-month follow-ups, with self-reported abstinence verified by saliva cotinine. We hypothesize that the CS-CBT condition will produce significantly greater smoking cessation rates compared to the control condition. We also expect that this effect will be moderated by acculturation and ethnic identity, such that the CS-CBT will show the greatest effect on cessation among participants who are less acculturated and have greater ethnic identity.DiscussionAnswering the fundamental question of whether culturally specific interventions lead to incremental efficacy over established, evidence-based approaches is of utmost importance. This study will have implications for the development and implementation of smoking cessation interventions among African Americans and other racial/ethnic minority groups.Trial registrationNCT01811758

Designing and Evaluating Culturally Specific Smoking Cessation Interventions for American Indian Communities

American Indians have the highest smoking rates in the United States, yet few randomized controlled trials of culturally specific interventions exist. This study assessed American Indians' opinions about evidence-based treatment and attitudes toward participating in clinical trials. Six focus groups were conducted based on smoking status (current/former smoker), sex, and elder status (55 years and older or younger). Meetings were held at local American Indian community organizations. This project was accomplished in partnership with the American Indian Community Tobacco Projects, a community-academic research partnership at the University of Minnesota. Thematic qualitative data analyses were conducted. Participants desired the following: (a) programs led by trained American Indian community members, (b) the opportunity to connect with other American Indian smokers interested in quitting, and (c) programs promoting healthy lifestyles. Strategies desired for treatment included (a) free pharmacotherapy, including nicotine replacement therapy (NRT); (b) nominal incentives, e.g., gift cards for groceries; and (c) culturally specific program components such as American Indian images, education on traditional tobacco use, and quit-smoking messages that target the value of family and include narratives or story telling in recruitment and program materials. Biochemical verification of smoking abstinence, such as salivary cotinine or carbon monoxide breathalyzers, is likely acceptable. Standard treatment or delayed treatment control groups were viewed as potentially acceptable for randomized study designs. Rigorously conducted randomized controlled trials of culturally specific smoking cessation interventions are sorely needed but will only be accomplished with the commitment of funders, researchers, and collaborative trusting relationships with the community.

The role of gender in a smoking cessation intervention: a cluster randomized clinical trial.

BackgroundThe prevalence of smoking in Spain is high in both men and women. The aim of our study was to evaluate the role of gender in the effectiveness of a specific smoking cessation intervention conducted in Spain.MethodsThis study was a secondary analysis of a cluster randomized clinical trial in which the randomization unit was the Basic Care Unit (family physician and nurse who care for the same group of patients). The intervention consisted of a six-month period of implementing the recommendations of a Clinical Practice Guideline. A total of 2,937 current smokers at 82 Primary Care Centers in 13 different regions of Spain were included (2003-2005). The success rate was measured by a six-month continued abstinence rate at the one-year follow-up. A logistic mixed-effects regression model, taking Basic Care Units as random-effect parameter, was performed in order to analyze gender as a predictor of smoking cessation.ResultsAt the one-year follow-up, the six-month continuous abstinence quit rate was 9.4% in men and 8.5% in women (p = 0.400). The logistic mixed-effects regression model showed that women did not have a higher odds of being an ex-smoker than men after the analysis was adjusted for confounders (OR adjusted = 0.9, 95% CI = 0.7-1.2).ConclusionsGender does not appear to be a predictor of smoking cessation at the one-year follow-up in individuals presenting at Primary Care Centers.ClinicalTrials.gov IdentifierNCT00125905.

Psychosocial Factors Associated With Weight Control Expectancies in Treatment-Seeking African American Smokers

African Americans are disproportionately affected by tobacco smoking and obesity. As weight control expectancies can reinforce smoking maintenance, the purpose of this study was to explore psychosocial factors related to expectancies for weight control among African Americans seeking cessation treatment. African American smokers (N = 117) provided information on demographics, family medical history, personal risk factors, smoking, weight control expectancies and concerns, perceived stress, and acculturation. Multivariate analyses examined hypotheses regarding determinants of weight control expectancies. Fifty-one percent of participants were concerned about gaining weight upon cessation. Positive expectations for weight control through smoking were associated with older age, a family history of heart disease, greater perceived stress, and a lower level of acculturation. In conclusion, many African American smokers are concerned about postcessation weight gain: expectations for weight control through smoking are most evident those with elevated perceived stress, traditional African American cultural values, and a family history of chronic illness. Needed are culturally specific smoking cessation interventions that include weight management strategies as an adjunct to smoking cessation treatments.

Population-based smoking cessation in women post partum: adherence to motivational interviewing in relation to client characteristics and behavioural outcomes

quantitative description of adherence to motivational interviewing (MI) in smoking cessation sessions; and examination of the relationships between client characteristics and adherence to MI, and between adherence to MI and future smoking status. 84 sessions were conducted during a randomised controlled trial to test the effectiveness of a population-based smoking intervention in women during the postpartum period. Demographic and behaviour-related variables were included in a logistic regression to predict adherence to MI. adherence was measured using the MI Treatment Integrity Scale. 38.1% of sessions showed good adherence to MI. Receiving a good MI session was not related to any demographic or behavioural variables. The relationship between adherence and intervention outcome after six months was not statistically significant (chi(2)=0.355, p=0.551). the smoking cessation sessions examined in this study failed to adhere to MI. There was no relationship between adherence to MI and behavioural outcome six months after the intervention, indicating that women who smoke post partum may be a high-risk group for whom specific smoking cessation interventions need to be developed.

Le diplôme inter-universitaire de tabacologie et d'aide au sevrage tabagique de Strasbourg : bilan pédagogique et impact professionnel

The aim of the post-graduate degree course on tobacco and smoking cessation is to train professionals who have dedicated themselves to the fight against tobacco and smoking. An educational assessment of the degree programme was carried out in order to evaluate its impact on practice. A questionnaire was mailed to 60 students registered in the programme at Strasbourg University between 1997 and 2002 (with a response rate of 71.6%). The evaluation was able to shed light on the strengths and weaknesses of the teaching in the programme and the level of student satisfaction. The tobacco control and smoking cessation interventions of the students before and after completing the course were compared in order to assess the impact on their professional practice. The programme's participants came from a variety of professions including medical doctors (74.4%), paramedical staff (16.3%) and other professions (6.9%). The students acknowledged the course's high level of quality (the teachers were appreciated, and the programme was comprehensive). The structure of the course was operational; however, the students admitted that they felt that the practical application and the interactive aspects of the learning (such as case studies, role playing, training in a specific smoking cessation intervention were insufficient. They also noted a lack of emphasis on treatments that do not rely on pharmacotherapy such as behavioural therapy and psychological support. Tobacco cessation related problems or side effects of quitting like weight gain, anxiety or insomnia were not appropriately developed. The majority of students were very satisfied with the theoretical basis of the curriculum and with their internship in a tobacco cessation consultation intervention. Today, 69% of the students trained are working in smoking cessation and tobacco control. They have been able to diversify their activities, going from prevention to tobacco cessation, and vice versa. Course tracks focusing on pregnant women, adolescents and behavioural therapies have now been introduced into the degree programme. In terms of further investing in the improvement of skills and competencies, the programme could better respond to the students' needs by taking into account the development of interactive teaching methods such as role playing and workshops.

Effect of treatment for nicotine dependence on alcohol and drug treatment outcomes

This study was designed to examine the effect of a policy banning smoking and a smoking-cessation intervention on alcohol and drug treatment outcomes. We compared long-term alcohol and drug treatment outcomes in two cohorts hospitalized for substance use treatment, subjected to different smoking policies and cessation interventions in two periods. The study included 314 male patients, aged 18–65. The intervention cohort was subjected to a total hospital smoking ban and concurrent drug and nicotine dependency treatment, with a requirement for nicotine abstinence during hospitalization. The control cohort was hospitalized under a policy permitting smoking in designated areas, with no specific smoking-cessation intervention. Current alcohol, drug, and tobacco use were ascertained by follow-up interview with patients 8–21 months after completion of treatment. There was a 60% response rate in the intervention group ( n = 92) and a 66% response rate in the control group ( n = 105). Among respondents, there were no significant differences between intervention and control groups in rates of “improvement” for alcohol, cocaine, or marijuana use, or for these drugs combined, although there was a nonsignificant trend toward less “improvement” in the intervention group. When nonrespondents were analyzed as treatment failures, the rate of “improvement” was significantly worse for cocaine users in the intervention group, but not for other drug users or for all patients combined. Ten percent of patients reported quitting smoking in the intervention group compared to 4% in the control group (difference not significant). Although patients resisted the mandatory nature of the smoking intervention, many continuing smokers requested information and referral for smoking cessation at the time of follow-up. These data suggest that concurrent intervention for nicotine dependence did not significantly harm treatment outcomes of patients using alcohol or marijuana as their drug of first choice. Due to a trend in this direction, this possibility should be investigated in randomized, controlled trials. The intervention was associated with a small increase in self-reported smoking cessation. There is considerable interest in this patient population in smoking cessation after completion of treatment.