Successful Cessation Research Articles

Impact of smoking cessation on metabolic parameters and renal function in patients with and without diabetes mellitus

Backgroud and objectivesAs patients with diabetes are at a significantly higher risk of cardiovascular diseases than those without diabetes, it is important to gain a clinical understanding of the differential effects of smoking cessation on several risk factors between patients with and without diabetes. Materials and methodsPatients who participated in a smoking cessation program received an assessment of the outcomes of interest. The outcomes were changes in metabolic parameters and renal function from baseline to 6-month follow-up after the smoking cessation program. ResultA total of 1,954 patients joined the smoking cessation program, and 1,381 patients were in the smoking cessation failure (SCF) group and 573 were in the smoking cessation success (SCS) group. The decrease in HbA1c after smoking cessation was only observed in patients with diabetes. Smoking cessation was also associated with a significant decrease in LDL cholesterol in patients with diabetes. In terms of renal function, smoking cessation was associated with an improvement in eGFR, and the trend was similar in patients with and without diabetes. ConclusionSuccessful smoking cessation was associated with improvement in renal function. Moreover, it was associated with improvements in HbA1c and LDL cholesterol in patients with diabetes, despite significant weight gain.

Social Determinants of Successful Smoking Cessation: An Eight-Year Analysis of Population Assessment of Tobacco and Health (PATH) Data.

Smoking cessation is a crucial public health goal due to its substantial impact on reducing the morbidity and mortality associated with tobacco use. However, significant disparities in smoking cessation success persist across socioeconomic groups in the United States. This study aimed to examine differences in smoking cessation rates among daily smokers based on race, ethnicity, and socioeconomic status (SES) using data from the Population Assessment of Tobacco and Health (PATH) study, spanning waves 1 to 6 (eight years). Longitudinal data from PATH were analyzed, focusing on baseline daily cigarette smokers followed over an eight-year period to assess cessation outcomes. SES was measured by education and poverty status. Successful smoking cessation was defined as sustained abstinence from cigarettes for 12 months or more at the final wave. Logistic regression models identified predictors of successful cessation, adjusting for potential confounders, including age, nicotine dependence, and access to cessation resources. The analysis revealed significant disparities in cessation success across racial, ethnic, and SES groups. Smokers living in poverty and those with lower educational attainment were less likely to achieve cessation success than their counterparts. Race (Black) and ethnicity (Latino) were also significantly associated with lower cessation success. This study highlights the social determinants of smoking cessation success among U.S. adult smokers, with lower success rates observed among those in poverty and with less educational attainment. These findings emphasize the need for targeted interventions that address the unique barriers to cessation faced by low-SES groups. Public health strategies should prioritize equitable access to cessation resources and culturally tailored interventions to reduce these disparities and improve cessation outcomes among all smokers.

Regional and social disparities in cessation behavior and motivation to quit among U.S. adult current smokers, Tobacco Use Supplement to the U.S. Census Bureau's Current Population Survey 2014-15 and 2018-19.

Variation in smoking cessation behaviors and motivators across the United States may contribute to health disparities. This study investigates regional differences over time in two key cessation motivators (quit interest and doctor's advice to quit) and two cessation behaviors (past-year quit attempts and recent successful cessation) across diverse demographic factors. Data were analyzed from two releases of the Tobacco Use Supplement to the U.S. Census Bureau's Current Population Survey (TUS-CPS) for the years 2014-15 and 2018-19. The analysis included sex, age, race and ethnicity, education, marital status, employment status, and household income. Findings from 2018 to 2019 TUS-CPS revealed that quit interest was highest in the Northeast and lowest in the Midwest, while doctor's advice to quit was most prevalent in the Northeast and least in the West. Past-year quit attempts were most common in the Northeast and least in the South. Recent successful cessation (defined as quitting for 6 to 12 months) was highest in the Northeast and Midwest, with the South showing the lowest rates. Compared to the 2014-15 survey, 14 demographic groups (7 in the Midwest, 6 in the South, and 1 in the West) showed decreases in both quit interest and actions to quit. Notably, the Asian non-Hispanic group in the Northeast experienced a significant decrease in quit interest (-17.9%) but an increase in recent successful cessation (+369.2%). Overall, the study indicates that while quit interest was highest in the West, the South exhibited the lowest rates of quit attempts and successful cessation. Significant differences were also noted between age groups. These findings highlight the need for further research into cessation behaviors at more granular levels to inform policies aimed at reducing smoking-related health disparities among populations facing the greatest challenges in cessation.

Tobacco Cessation: Screening and Interventions.

Tobacco use has been the leading cause of disease and death in South Korea. Early detection of tobacco use and evidence-based interventions play pivotal roles in facilitating tobacco cessation. In accordance with the earlier iterations of the Lifetime Health Maintenance Program (2009) and recent recommendations from the United States Preventive Services Task Force (USPSTF; 2021), two themes were chosen for investigation: the identification of and intervention for tobacco use. The USPSTF recommendations were formulated by conducting an overview of reviews. In this study, literature searches and quality assessments of reviews were conducted. The findings highlighted the efficacy of physician-led identification and advising in promoting tobacco cessation, with robust evidence supporting the implementation of behavioral and pharmacological interventions. These interventions significantly increased the likelihood of successful cessation compared with usual care. Digital interventions, such as internet- or mobile-based interventions, showed additive effects for quitting. Identification and targeted interventions are essential for tobacco cessation. By leveraging evidencebased strategies and enhancing access to resources, healthcare providers can empower individuals to achieve successful tobacco cessation and improve overall health outcomes.

Sociodemographic inequalities in smoking cessation: a population survey from Flanders, Belgium

Abstract Background Flanders’ decline in daily tobacco use will not reach the aim of a 5% prevalence by 2040. A faster reduction necessitates, especially among low-educated and socially vulnerable groups, as in these groups the decline goes slower. Towards future smoking cessation interventions within these specific target groups, this study examined prevalence and sociodemographic inequalities in different indicators of smoking cessation in Flanders. Methods Data from the 2022 Prevention Barometer, a probability-based survey from Flanders, were used (N = 4011, 18+). Prevalence in ever smokers was calculated overall and by age, sex, educational attainment, making ends meet and employment status. Daily smokers reported their past-year quit smoking attempts, upcoming-year quit smoking intentions and intentions to use cessation aids. Former smokers reported successful cessation and use of cessation aids. Multivariate logistic regressions, including all demographic variables, aimed to uncover inequalities. Results Quit smoking attempts in daily smokers (26.5%) were lower for low education (vs. middle and high education). Quit smoking intentions in daily smokers (41.0%) were lower for low vs. middle and low vs. high education. Daily smokers had lower intentions to use cessation aids (48.5%) when having difficulties in making ends meet. Among ever smokers, being older, having high education (vs. middle and low education), having no difficulties in making ends meet and being retired (vs. working and not working) was associated with higher odds for successful quitting (73.2%). Among former smokers, people being retired (vs. working and not working) had higher odds of using cessation aids (15.3%). Conclusions Low educated daily smokers are less likely to quit smoking. Former smokers limitedly use cessation aids to quit smoking and the use varies regarding one’s sociodemographic profile. Encouraging quit attempts and equitable access to cessation aids are public health priorities. Key messages • Low-educated smokers in Flanders face barriers in quitting, highlighting the need for targeted cessation support. • Socioeconomic disparities impact cessation aid utilization, underlining the importance of equitable access to aid for all demographics.

Understanding smoking cessation process in Tunisia from 2020 to 2023: description of quit attempts

Abstract Background Many smokers attempt multiple cessation methods before seeking specialist intervention. This study aims to describe these prior cessation attempts and identify relapse factors to enhance support for these individuals. Methods Data from 440 patients consulting the Department of Epidemiology Statistics at Abderrahman Mami Hospital from 2020 to 2023 were analyzed. It included information on previous quit attempts, methods used, longest duration of abstinence, number of attempts, reaction to cessation, and reasons for relapse. Statistical description was conducted using IBM SPSS 25. Results Among participants, More than half of the smokers had previously attempted to quit smoking 63,4%, with an average of 2 attempts ± 1,7 (0-10 attempts) per patient. The majority of patients (86.8%) quit smoking without using substitution methods. Among those who resorted to substitution, nicotine replacement therapy was the most frequently used method (n = 30; 6.8%). The longest duration of abstinence averaged 8 years. The main reaction to smoking cessation among patients was an improvement in their health (9,1%). The most common reasons for relapse were psychosocial problems (5.5%), followed by relapses during social events (4.3%), and withdrawal symptoms (3%). Conclusions This study emphasizes the importance of considering each patient’s journey during their smoking cessation process. Analyzing these factors will enable better management of the cessation program with the patient, as well as a deeper understanding of their feedback regarding our program, ensuring long-term cessation success. Key messages • Failed spontaneous quit attempts prior to NRT initiation are prevalent among smoking patients. • Understanding failed spontaneous cessation attempts can guide the development of more effective strategies.

75 Lung ultrasound severity scores and its utility in predicting success of weaning off respiratory support in neonates born preterm

Abstract Background Preterm infants often require respiratory support in the newborn intensive care unit. Complete trial off around 30-34 weeks post-menstrual age (PMA) is by trial and error based on clinical and physiological variables. Lung ultrasound (LUS) is a reliable adjunct in the diagnosis and management of most neonatal lung conditions. However, its utility in accessing readiness for successful weaning off respiratory pressure support in preterm neonates has not been explored. Objectives To determine the utility of LUS severity score (LUS-sc) in predicting successful weaning off of respiratory pressure support after 32weeks CGA in neonates born ≤32 weeks gestational age (GA). Design/Methods Prospective cohort study involving preterm neonates born ≤32 weeks needing any respiratory pressure support modes, admitted to a single tertiary care center in Canada between Sept 2022-Sept 2023. Eligible neonates were assessed by LUS at two time points- LUS1 at 30-30 + 6 weeks for those born <30weeks GA and between 48-72hours of life for those born at 30-32 + 6 weeks GA; LUS2 within 12hours prior to trial off respiratory pressure support to room air or low flow after 32weeks PMA. LUS were scored for disease severity by two independent reviewers using the LUS-sc by Brat et al. Receiver operator characteristics (ROC) curves analyzed the reliability of LUS-sc to predict the successful cessation of respiratory pressure support to room air or low flow post LUS2. Results Of 50 preterm neonates included in the study, 32 (64%) were successfully weaned from pressure support after LUS2 at a mean (SD) GA of 33.03 (0.29). The mean (SD) GA at birth was 28.78 (0.46) in the successful group and 27.78 (0.62) in the unsuccessful group (p=0.197). The mean (SD) LUS-sc for LUS2 at which cessation of support was possible was significantly lower from those who failed [6.95(0.33) vs 8.69(0.55), p=0.006] (Table 1). The ROC curve (Figure 1) showed AUC of 0.717 (95%CI=0.56-0.86), for a cut-off of LUS-sc of 7.75, with sensitivity of 0.75 (95%CI=0.60-0.90) and specificity of 0.61 (95%CI=0.38-0.84). Independent of GA at birth and at respiratory pressure support trial off, LUS-sc ≤8 was associated with an increased odd of cessation of support by 9.0 (95%CI=1.9-42.6), p=0.005, and each additional week of GA at first trial off increased the odds of cessation by 2.2 (95%CI=1.1-4.4), p=0.031. Conclusion LUS is a reliable tool to assess readiness for successful non-invasive respiratory pressure support trial off. A LUS-sc ≤8 was associated with higher successful weaning off of non-invasive pressure support after 32weeks GA.

A mixed-method exploration of #vapingcessation videos on TikTok.

E-cigarette use has risen rapidly, especially among young people. TikTok is one of the most commonly used social media platforms among young people. The representation of vaping cessation messages in TikTok content remains unexplored. We aimed to address this gap by analyzing the vaping cessation content prevalent on TikTok. This cross-sectional mixed methods study analyzed the top 100 TikTok videos-determined based on view-counts-related to vaping cessation. Our quantitative analysis examined video characteristics, while our qualitative analysis identified key thematic representations. The final sample included 87 videos, with a combined total of over 100 billion views. Most videos were created by regular users (general TikTok content creators) rather than those identifying as health experts or professionals such as doctors, acupuncturists or dental hygienists. Very few posts mentioned evidence-based cessation aids or support. Videos scored high on understandability but low on actionability based on standardized criteria. Qualitative analysis identified nine key themes: motivations for quitting, barriers to quitting, use of aids and strategies, relapse experiences, identity and self-image, celebrating cessation success, emotional journey of quitting vaping, seeking social support, and limited mentions of healthcare providers. TikTok appears to be a useful influential forum for studying quitting behavior through the sharing of personal experiences and perspectives on vaping cessation. Opportunities exist to integrate evidence-based messaging and support into this platform. Findings can inform social media interventions designed to counter pro-vaping content and promote quitting e-cigarette use. Partnerships among health professionals, public health experts, and social media influencers may be leveraged to disseminate proven vaping cessation techniques on leading social media platforms such as TikTok.

Is unassisted smoking cessation choice and success associated with high mental stress? Evidence from six cities in China.

Unassisted smoking cessation (USC) is a method of quitting smoking driven by self-determination without the support of professional cessation assistance. This approach may contribute to a potential decrease in overall smoking prevalence within a population. However, the factors potentially influencing smokers' choice of USC and their success remain unclear. This study examined the associations between mental stress and USC choice and success. Between June and September 2016, a cross-sectional multistage sampling design was used to interview subjects from six selected cities in China. A standardized questionnaire was used to obtain information on sociodemographic characteristics, USC choice, and success. Mental stress was measured by the Chinese version of the Perceived Stress Scale (CPSS). Multivariate logistic regression models were used to examine the association between mental stress, USC choice, and success, with adjustments for relevant covariates. Among 1647 smokers who had attempted or had quit, 91.6% (95% CI: 90.9-97.5) reported that they had done so without assistance, and 42.1% (95% CI: 32.4-61.3) of them achieved abstinence. While mental stress was not significantly associated with USC success (χ2=2.02, p=0.1547), smokers experiencing high levels of mental stress were 0.34 times less likely (95% CI: 0.23-0.50) to attempt USC compared to those with low levels of mental stress. Moreover, a significant negative linear association was observed between varying levels of mental stress and the prevalence of USC use (R2=0.910, p<0.001). The study findings should help to understand USC and its role in reducing smoking prevalence in the Chinese population. These findings can inform future tobacco control programs and policies in China. Government and social agencies should prioritize understanding smokers' preferences for USC and providing USC services to promote success within the population.

Effects of in vivo NRT sampling on smoking abstinence and NRT adherence: A randomized clinical trial

BackgroundNicotine replacement therapy (NRT) is an effective treatment but is associated with poor adherence during smoking cessation attempts. This study aimed to determine if In Vivo Sampling, an experiential intervention that includes sampling of NRT in-session, increases NRT adherence and smoking abstinence compared to standard smoking cessation behavioral counseling. MethodsEligible participants were under community corrections supervision and smoked five or more cigarettes per day for the past year. Participants were randomly assigned to receive either In Vivo Sampling or standard smoking cessation behavioral counseling. Both interventions involved four 30-minute sessions and received 12 weeks of combination NRT. Self-reported NRT adherence, quit attempts, and carbon monoxide (CO)-verified smoking cessation were measured at one, three-, and six-months post-intervention. ResultsFrom 2017–2022, 515 participants were enrolled and randomized. The In Vivo Sampling group had significantly greater mean adherence to patch and lozenge NRT regimens (71 % vs. 60 %, OR: 1.63, 95 % CI: 1.36–1.96, p<.001). The In Vivo group had a significantly higher likelihood of quit attempts across time (61 % vs. 53 %, OR: 1.4, 95 % CI: 1.05–1.87, p=.021). Groups did not significantly differ on the percent of participants who had quit smoking at 6 months post-intervention (17 % In Vivo Sampling vs. 13 % standard counseling, OR: 1.43, p=.24). ConclusionIn Vivo Sampling demonstrated better NRT adherence and quit attempts but similar cessation rates to standard behavioral counseling. The In Vivo Sampling intervention represents a novel approach that increased behaviors typically associated with successful cessation over standard behavioral counseling.

Smokers' Characteristics Associated with Successful Smoking Cessation Undergoing Pharmacotherapy in Slovenia.

Tobacco use is a major global health problem, contributing to premature death and disability. In Slovenia, the prevalence of smoking is higher than the EU average, emphasizing the need for effective tobacco control measures. The aim of this study was to identify the characteristics of patients most likely to benefit from pharmacotherapy for smoking cessation. We performed cross-sectional analysis of factors associated with successful smoking cessation using pharmacotherapy for Slovenian smokers. A total of 176 (24.6%) smokers with an average age of 50 years agreed to receive pharmacotherapy for their smoking cessation attempt and were enrolled in the study. Participants were followed up at 4-week intervals during treatment and for 24 weeks after completion of pharmacotherapy. Attempts to quit smoking with prescription medications were successful in 24.4% of those willing to try. Female smokers, older persons, those with more children, with a lower self-perception of health, a higher number of cigarettes per day and a higher nicotine dependence were more likely to attempt to quit smoking. However, the strongest predictors of smoking cessation success were lower nicotine dependence, which was tested using the Fagerström test for nicotine dependence, and higher adherence to pharmacotherapy. Nicotine dependence and adherence to pharmacotherapy are the strongest predictors of a successful smoking cessation attempt. Identification of potential responders, prescription of pharmacotherapy and follow-up are applicable in the primary healthcare setting.

Increasing Population Immunity Prior to Globally-Coordinated Cessation of Bivalent Oral Poliovirus Vaccine (bOPV).

In 2022, global poliovirus modeling suggested that coordinated cessation of bivalent oral poliovirus vaccine (bOPV, containing Sabin-strain types 1 and 3) in 2027 would likely increase the risks of outbreaks and expected paralytic cases caused by circulating vaccine-derived polioviruses (cVDPVs), particularly type 1. The analysis did not include the implementation of planned, preventive supplemental immunization activities (pSIAs) with bOPV to achieve and maintain higher population immunity for types 1 and 3 prior to bOPV cessation. We reviewed prior published OPV cessation modeling studies to support bOPV cessation planning. We applied an integrated global poliovirus transmission and OPV evolution model after updating assumptions to reflect the epidemiology, immunization, and polio eradication plans through the end of 2023. We explored the effects of bOPV cessation in 2027 with and without additional bOPV pSIAs prior to 2027. Increasing population immunity for types 1 and 3 with bOPV pSIAs (i.e., intensification) could substantially reduce the expected global risks of experiencing cVDPV outbreaks and the number of expected polio cases both before and after bOPV cessation. We identified the need for substantial increases in overall bOPV coverage prior to bOPV cessation to achieve a high probability of successful bOPV cessation.

Cannabis Use and Subsequent CIGARETTE Discontinuation among U.S. Adults in the Population Assessment of Tobacco and Health (PATH) Study, Waves 1-5.

This study examined the association between current co-use of cannabis and cigarettes in the past 30 days, and subsequent cigarette discontinuation (past 30-day point prevalence abstinence) among U.S. adults with established cigarette use in the Population Assessment of Tobacco and Health (PATH) Study. Additionally, we investigated the impact of co-use on the subsequent discontinuation of all combustible tobacco products. A total of 26,381 observations contributed by 8,218 adults with established cigarette use (i.e., smoked ≥ 100 cigarettes in their lifetime, and currently smoking cigarettes every day or some days) from Waves 1-5 of the PATH Study were included in the analysis. Weighted Generalized Estimating Equations (GEE) models were used to evaluate the association between current co-use at baseline (Waves 1-4) with the outcomes assessed at the subsequent wave (cigarette and combustible tobacco discontinuation at Waves 2-5). Final models included: demographic characteristics (age, sex, race and ethnicity, educational attainment), behavior characteristics (intention to quit, internalizing symptoms, externalizing symptoms, substance use problems), and wave-pair. Over one-third (35.91%) of cigarette users self-reported co-use during the study period. Cannabis use among adults with established cigarette use increased over time. Co-use was associated with a decreased odds of cigarette smoking discontinuation at follow-up, after adjusting for covariates (aOR: 0.81; 95% CI: 0.72, 0.93; p=0.0018). Similar effect sizes were observed for discontinuation of all combustible tobacco products (aOR: 0.75; 95% CI: 0.65, 0.86; p<.0001). Cannabis use among adults who smoke cigarettes was inversely related to subsequent cigarette discontinuation, suggesting that co-use may reduce likelihood of successful tobacco cessation. Findings demonstrate that cannabis use may lead to lower odds of discontinuation among adults with established cigarette use; therefore, individuals that co-use cigarettes and cannabis may need additional tobacco cessation support. Notably, this study observed an increase in co-use of cigarettes and cannabis, emphasizing the need for researchers and public health programs to shift their focus towards understanding and addressing concurrent substance use among adults who smoke cigarettes.

Impact of the Ottawa model on opiate screening and smoking cessation in methadone-treated patients with opioid use disorder: A retrospective cohort analysis.

Approximately 60 million individuals worldwide used opioids in 2021, constituting 1.2% of the global adult population. This study aimed to evaluate the effectiveness of integrated treatment strategies for opioid use disorder and nicotine use disorder by assessing the impact of smoking cessation within a methadone treatment framework. In a retrospective cohort study, 53 methadone maintenance patients were divided into 16 treatment-seeking smokers (TSS) and 37 treatment-rejecting smokers (TRS) based on their participation in the Ottawa model for smoking cessation plus 16 weeks of varenicline treatment. Both groups received standard methadone treatment for 68 weeks. TSS were followed up for 44 weeks to assess smoking cessation outcomes, while TRS had none due to their lack of participation in smoking cessation treatment. The median age of the TSS group was 48 years, while that of the TRS group was 45.5 years. Males comprised 75% of TSS and 94.6% of the TRS. TSS exhibited an 83% decrease in positive opioid screen results compared to TRS (p=0.023). In TSS, peak smoking cessation success was observed at week 20, with 57% of participants maintaining carbon monoxide levels <5 ppm. The significant reduction in positive opioid screens and the high smoking cessation rate in the TSS group highlight the efficacy of combined treatment methods. This study underscores the advantages of integrating smoking cessation with methadone maintenance treatment, indicating that comprehensive approaches can substantially improve treatment outcomes.

Impact of Smoking Cessation and Charlson Comorbidity Index on Influenza Vaccination Efficacy in COPD Patients.

Chronic obstructive pulmonary disease (COPD) patients are particularly susceptible to respiratory infections like influenza, which exacerbate symptoms and increase healthcare utilization. While smoking cessation and influenza vaccination are recommended preventive measures, their combined impact on healthcare resource utilization is underexplored. The Charlson Comorbidity Index (CCI) assesses comorbidity burden in COPD patients and may influence healthcare outcomes. We conducted a retrospective analysis of 357 COPD patients, evaluating smoking cessation success over one year and influenza vaccination receipt, stratifying patients by CCI scores. Healthcare utilization outcomes included emergency room visits, hospitalizations, and medical expenses. Results showed that 51.82% of patients quit smoking and 59.66% received influenza vaccination, with higher comorbidity prevalence in advanced COPD stages (p = 0.002). Both smoking cessation and influenza vaccination independently correlated with decreased emergency room visits, hospital admissions, days, and costs. Patients who both quit smoking and received influenza vaccination exhibited the lowest healthcare utilization rates. In conclusion, smoking cessation and influenza vaccination significantly reduce healthcare resource utilization in COPD patients, with the combination yielding synergistic benefits, particularly in those with lower CCI scores. Integrating these interventions and comorbidity management in COPD strategies is essential for optimizing patient outcomes and healthcare efficiency.

Intention to Quit Smoking Scale: Development and Validation

Smoking cessation efforts are made in many countries and the results of these efforts should be measured. Therefore, there is a need for a short, feasible and validated scale that can measure the intention to quit smoking. The purpose of this study is to investigate the psychometric properties of the “Intention to Quit Smoking Scale (IQSS)”. Validity and reliability properties of the scale were examined. A total of 497 people were included in the study. First, 20 candidate items were prepared based on literature review and expert opinions and the scale with candidate items were subjected to a pilot test. The dimensional structure was determined statistically using confirmatory factor analysis and confirmed by confirmatory factor analysis. Cronbach’s α coefficient, CR and AVE values were calculated to examine internal consistency, composite reliability and convergent validity. A scale with one factor consisting of eight items was obtained. The fit indices of the single factor structure were at an acceptable level (X2/df 1.77, GFI 0.94, AGFI 0.88, CFI 0.98, NFI 0.97, RMSEA 0.079). Cronbach's alpha for IQSS was 0.943. CR was 0.95 and AVE was 0.96. The test-retest consistency of the scale was high (r=0.856). Correlations with “Smoking Cessation Success Prediction Scale” and its sub-dimensions showed that the scale provided concurrent validity (r=0.669; 0.698; 0.721 respectively). The IQSS is a short, reliable and valid scale that can measure the intention to quit smoking at the time of measurement and it can be easily used in future studies.

Factors influencing smoking cessation attempts and success in Iranian male adults: national survey data

BackgroundSmoking cessation is a dynamic process that often involves a series of unsuccessful quit attempts before long-term abstinence is achieved. To implement interventions that lead to long-term abstinence, it will be necessary to understand the determinants of smoking cessation. Therefore, the main objective of the present study was to determine the effect of factors influencing both smoking cessation attempts and successful smoking cessation in the general population of Iran.MethodsThe data of 1293 participants whose information was obtained through a national cross-sectional study entitled “Survey of Risk Factors of Noncommunicable Diseases in 2016” were analyzed. There were three response levels: “quit attempt and successful quit”, “quit attempt and unsuccessful quit”, and “no quit attempt and unsuccessful quit”. A multinomial logistic regression model was used to assess the effect of covariates on response.ResultsThe mean (sd) age of all participants was 47.21 (13.65) years. According to the results, 883 people (68.29%) did not attempt to quit smoking, and of those who attempted to quit smoking, only 64 (15.61%) men were successful. The factors of living in an urban area (OR = 1.71) and past smoking intensity (OR = 1.967) were associated with no quit attempt and unsuccessful quitting. In addition, physician recommendation to quit smoking was a protective factor for no quit attempt and unsuccessful quit (OR = 0.599). Alcohol consumption was also a protective factor against successful quitting for both attempters (OR = 0.351) and nonattempters (OR = 0.359).ConclusionsTobacco control programs should be implemented with a greater focus on heavy smokers and alcohol users. In addition, the role of health professionals in encouraging smokers to quit smoking should not be ignored.

Rates and Predictors of Pain Reduction With Intracranial Stimulation for Intractable Pain Disorders.

Intracranial modulation paradigms, namely deep brain stimulation (DBS) and motor cortex stimulation (MCS), have been used to treat intractable pain disorders. However, treatment efficacy remains heterogeneous, and factors associated with pain reduction are not completely understood. We performed an individual patient review of pain outcomes (visual analog scale, quality-of-life measures, complications, pulse generator implant rate, cessation of stimulation) after implantation of DBS or MCS devices. We evaluated 663 patients from 36 study groups and stratified outcomes by pain etiology and implantation targets. Included studies comprised primarily retrospective cohort studies. MCS patients had a similar externalized trial success rate compared with DBS patients (86% vs 81%; P = .16), whereas patients with peripheral pain had a higher trial success rate compared with patients with central pain (88% vs 79%; P = .004). Complication rates were similar for MCS and DBS patients (12% vs 15%; P = .79). Patients with peripheral pain had lower likelihood of device cessation compared with those with central pain (5.7% vs 10%; P = .03). Of all implanted patients, mean pain reduction at last follow-up was 45.8% (95% CI: 40.3-51.2) with a 31.2% (95% CI: 12.4-50.1) improvement in quality of life. No difference was seen between MCS patients (43.8%; 95% CI: 36.7-58.2) and DBS patients (48.6%; 95% CI: 39.2-58) or central (41.5%; 95% CI: 34.8-48.2) and peripheral (46.7%; 95% CI: 38.9-54.5) etiologies. Multivariate analysis identified the anterior cingulate cortex target to be associated with worse pain reduction, while postherpetic neuralgia was a positive prognostic factor. Both DBS and MCS have similar efficacy and complication rates in the treatment of intractable pain. Patients with central pain disorders tended to have lower trial success and higher rates of device cessation. Additional prognostic factors include anterior cingulate cortex targeting and postherpetic neuralgia diagnosis. These findings underscore intracranial neurostimulation as an important modality for treatment of intractable pain disorders.

Moderation of the real-world effectiveness of smoking cessation aids by mental health conditions: A population study

Objective To examine whether the real-world effectiveness of popular smoking cessation aids differs between users with and without a history of mental health conditions. Design Nationally-representative cross-sectional survey conducted monthly between 2016–17 and 2020–23. Setting England. Participants 5,593 adults (2,524 with a history of ≥1 mental health conditions and 3,069 without) who had smoked regularly within the past year and had attempted to quit at least once in the past year. Main outcome measures The outcome was self-reported abstinence from quit date up to the survey. Independent variables were use of the following cessation aids during the most recent quit attempt: prescription nicotine replacement therapy (NRT), NRT over-the-counter, varenicline, bupropion, vaping products, face-to-face behavioural support, telephone support, written self-help materials, websites, hypnotherapy, Allen Carr’s Easyway, heated tobacco products, and nicotine pouches. The moderator was history of diagnosed mental health conditions (yes/no). Covariates included sociodemographic characteristics, level of cigarette addiction, and characteristics of the quit attempt. Results Relative to those without, participants with a history of mental health conditions were significantly more likely to report using vaping products (38.8% [95%CI 36.7–40.8] vs. 30.7% [28.9–32.5]), prescription NRT (4.8% [3.9–5.7] vs. 2.7% [2.1–3.3]), and websites (4.0% [3.2–4.8] vs. 2.2% [1.6–2.7]). Groups did not differ significantly in their use of other aids. After adjusting for covariates and use of other cessation aids, those who used vaping products (OR = 1.92, 95%CI 1.61–2.30), varenicline (OR = 1.88, 95%CI 1.19–2.98), or heated tobacco products (OR = 2.33, 95%CI 1.01–5.35) had significantly higher odds of quitting successfully than those who did not report using these aids. There was little evidence that using other cessation aids increased the odds of successful cessation, or that the user’s history of mental health conditions moderated the effectiveness of any aid. Conclusions Use of vaping products, varenicline, or heated tobacco products in a quit attempt was associated with significantly greater odds of successful cessation, after adjustment for use of other cessation aids and potential confounders. There was no evidence to suggest the effectiveness of any popular cessation aid differed according to the user’s history of mental health conditions.

Evaluating the effectiveness of the maximum permitted dose of midazolam in seizure termination: Insights from New South Wales, Australia.

Out-of-hospital seizures demand rapid management. Midazolam plays a key role in stopping seizures. At times the first dose of midazolam proves insufficient, necessitating additional doses. Within the New South Wales Ambulance (NSWA) service, the upper limit for midazolam administration is set at 15 mg. However, the outcomes and safety of using midazolam at this maximum dosage have not been thoroughly investigated. A retrospective analysis of out of hospital electronic health records from New South Wales, Australia, over the year 2022, was conducted. The study manually reviewed cases where adult patients received the maximum dose of midazolam for seizure management by paramedics. It focused on seizure cessation success rates and the incidence of adverse effects to evaluate the clinical implications of high-dose midazolam administration. Of 818 790 individual attendances by NSWA clinicians, a total of 11 392 (1.4%) adults had seizures noted, of which midazolam was administered in 2565 (22.5%). An algorithm shows that in 2352 (91.7%) instances the midazolam was associated with the apparent termination of seizures. Analysis revealed that 176 (1.5%) proportion of all adult's seizure patients required the maximum dose of midazolam for seizure control. These higher doses successfully terminate seizures in about half of the instances. AEs following the maximum dose of midazolam included hypoxia in 26.7% of patients and respiratory depression in 9.7%, indicating significant side effects at higher dosages. In New South Wales, Australia, administering the maximum dose of midazolam to seizure patients is rare but proves effective in approximately half of the refractory seizure cases. Therefore, assessing the potential for additional doses of midazolam or the use of a second-line agent is advisable.