Successful Cessation Research Articles

Predictors of successful discontinuation of continuous kidney replacement therapy in a pediatric cohort

BackgroundRecognizing the optimal time to discontinue continuous kidney replacement therapy (CKRT) is necessary to advance patient recovery and mitigate complications. The aim of this study was to identify predictors of successful CKRT cessation in pediatric patients.MethodsAll patients requiring CKRT between January 2010 and March 2021 were evaluated. Patients on peritoneal or hemodialysis, who transferred between institutions, or who did not trial off CKRT were excluded. Successful discontinuation was defined as remaining off CKRT for at least 7 days. Demographics, admission diagnoses, PRISM III scores, and reasons for CKRT initiation were obtained. Clinical and biochemical variables were evaluated at CKRT initiation and discontinuation and in the 12-h period following discontinuation. Comparisons were conducted using Wilcoxon rank sum and Fisher’s exact tests for continuous and categorical variables, respectively. A logistic regression model was fitted to identify significant factors.ResultsNinety-nine patients underwent a trial off CKRT. Admission and initiation characteristics of the success and failure groups were similar. Patients who required re-initiation (n = 26) had longer ICU lengths of stay (27.2 vs. 44.5 days, p = 0.046) and higher in-hospital mortality (15.1% vs. 46.2%, p = 0.002). Urine output greater than 0.5 mL/kg/h irrespective of diuretic administration in the 6-h period before CKRT discontinuation was a significant predictor (AUC 0.72, 95% CI 0.60–0.84, p = 0.0009).ConclusionsDetermining the predictors of sustained CKRT discontinuation is critical. Urine output greater than 0.5 mL/kg/h in this pediatric cohort predicted successful discontinuation. Future studies are needed to validate this threshold in disease- and age-specific cohorts and evaluate additional biomarkers of kidney injury.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Probability of successful inhaled corticosteroids cessation in preschool wheezers: a predictive score.

Predictors of less successful ICS cessation were the following: perinatal oxygen use, allergic rhinitis, blood eosinophil count > 500 cell/mm3, and previous ICS use > 6months. A simple predictive score developed in this study may help general practitioners to be more confident in making a decision regarding the discontinuation of ICS after initial therapeutic trials. • Early allergic sensitization is associated with reduced chances of inhaled corticosteroid cessation at school age. • Prolonged ICS is associated with the emergence of adverse effect and discontinuing too early can result in recurrence symptoms. • Requirement of oxygen support within 7 days after birth in term neonate is a postnatal factor associated with less successful ICS cessation. • We propose a simple predictive tool with easily available clinical parameters (perinatal oxygen use, allergic rhinitis, blood eosinophil count, parental asthma history, and duration of previous ICS use) to determine the timing of inhalational corticosteroid cessation in preschool wheezers.

Acceptance of a Prescription for Smoking Cessation Utilizing an iPad Educational Application

Tobacco use, especially smoking, poses an enormous threat to public health. Research indicates tobacco use is linked to many illnesses and premature death. It also has unhealthy consequences in non-smokers through second-hand exposure. Primary care clinicians have the “golden opportunities” to intervene during office visit encounters. This study examined the use of an iPad educational application in tobacco cessation counseling that would increase acceptance of a prescription to aid with cessation, compared to the traditional method of counseling only. Utilizing smoking cessation guidelines, a descriptive quantitative exploratory methodology was used in two phases to assess the effectiveness of tobacco cessation education in a traditional verbal counseling versus the additional use of a mobile application along with standard tobacco cessation counseling in a primary care clinical setting. Total of 49 participants were recruited in two different groups. The standard cessation counseling had 29 subjects for Phase I and 20 participants in the enhanced tobacco cessation education group in Phase II. The enhanced tobacco cessation education with an iPad was more effective in smoking education than the traditional standard verbal counseling on smoking cessation. The addition of a mobile device with relevant educational materials shared with smokers by clinicians have shown an increase in acceptance of a prescription to aid tobacco cessation. Clinicians are strongly encouraged to find innovative ways to help smoking patients accept aids in successful cessation attempts.

Routine Islet Autoantibody Testing in Clinically Diagnosed Adult-Onset Type 1 Diabetes Can Help Identify Misclassification and the Possibility of Successful Insulin Cessation.

Recent joint American Diabetes Association and European Association for the Study of Diabetes guidelines recommend routine islet autoantibody testing in all adults newly diagnosed with type 1 diabetes. We aimed to assess the impact of routine islet autoantibody testing in this population. We prospectively assessed the relationship between islet autoantibody status (GADA, IA-2A, and ZNT8A), clinical and genetic characteristics, and progression (annual change in urine C-peptide-to-creatinine ratio [UCPCR]) in 722 adults (≥18 years old at diagnosis) with clinically diagnosed type 1 diabetes and diabetes duration <12 months. We also evaluated changes in treatment and glycemia over 2 years after informing participants and their clinicians of autoantibody results. Of 722 participants diagnosed with type 1 diabetes, 24.8% (179) were autoantibody negative. This group had genetic and C-peptide characteristics suggestive of a high prevalence of nonautoimmune diabetes: lower mean type 1 diabetes genetic risk score (islet autoantibody negative vs. positive: 10.85 vs. 13.09 [P < 0.001] [type 2 diabetes 10.12]) and lower annual change in C-peptide (UCPCR), -24% vs. -43% (P < 0.001).After median 24 months of follow-up, treatment change occurred in 36.6% (60 of 164) of autoantibody-negative participants: 22.6% (37 of 164) discontinued insulin, with HbA1c similar to that of participants continuing insulin (57.5 vs. 60.8 mmol/mol [7.4 vs. 7.7%], P = 0.4), and 14.0% (23 of 164) added adjuvant agents to insulin. In adult-onset clinically diagnosed type 1 diabetes, negative islet autoantibodies should prompt careful consideration of other diabetes subtypes. When routinely measured, negative antibodies are associated with successful insulin cessation. These findings support recent recommendations for routine islet autoantibody assessment in adult-onset type 1 diabetes.

Cigarette Smoking Among US Adults With Selected Chronic Diseases Associated With Smoking, 2010-2019.

IntroductionPeople who smoke cigarettes are at greater risk of developing chronic diseases and related complications. Our study provides recent estimates and trends in cigarette smoking among people with respiratory and cardiovascular diseases, cancers, and diabetes.MethodsUsing data from the 2019 National Health Interview Survey, we calculated the prevalence of current and former cigarette smoking among adults aged 18 to 44 years, 45 to 64 years, and 65 years or older with chronic diseases. Those diseases were cancers associated with smoking, chronic obstructive pulmonary disease, diabetes, coronary heart disease, and/or stroke (N = 3,741). Using data from the 2010–2019 National Health Interview Surveys, we assessed trends in current cigarette smoking by chronic disease by using the National Cancer Institute’s Joinpoint Regression Program.ResultsIn 2019, current cigarette smoking prevalence among adults with chronic diseases associated with smoking ranged from 6.0% among adults aged 65 or older with diabetes to 51.9% among adults aged 18 to 44 years with 2 or more chronic diseases. During 2010 through 2019, a significant decrease occurred in current cigarette smoking among adults aged 45 to 64 years with diabetes.ConclusionOverall, smoking prevalence remains high and relatively unchanged among people with chronic diseases associated with smoking, even as the overall prevalence of cigarette smoking in the US continues to decrease. The lack of progress in smoking cessation among adults with chronic diseases associated with smoking suggests that access, promotion, and integration of cessation treatment across the continuum of health care (ie, oncology, pulmonology, and cardiology settings) may be important in the success of smoking cessation in this population.

Evaluation of factors affecting smoking cessation in people treated with Varenicline

Objective: Aim of the study is to evaluate factors affecting treatment success among individuals receiving varenicline therapy for smoking cessation. Material and Methods: This research was carried out at Istanbul Medeniyet University Göztepe Training and Research Hospital between January 2018 and January 2019. A total of 209 patients in the smoking cessation outpatient clinic who were treated with varenicline Varenicline were constituted into the study group. The Fagerstrom Nicotine Dependence Level Test (FTND) was used to determine individuals' nicotine addiction levels, and the Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression levels. Results: There were 90 (43.1%) women and 119 (56.9%) men in the study group and mean age was 41.34 ± 10.93 (21-64) years. Overall, 63.2% (n=132) of varenicline recipients quit smoking. The frequency of quitting smoking due to physician advice was higher in those who quit than those who did not (p=0.011). Multiple logistic regression revealed that the independent factors associated with the lower likelihood of smoking cessation were higher number of cigarettes per day (p=0.008), higher HADS-Total score (p&lt;0.001), post-treatment nervousness (p=0.046), and post-treatment depressive mood (p=0.007), whereas being able to remain smoke-free for longer periods in previous quitting attempts was associated with higher likelihood of success (p=0.005). Conclusion: The success of smoking cessation with varenicline therapy is lower in the presence of the following factors: having high risk for anxiety and depression, smoking a greater number of cigarettes per day, shorter periods of remaining smoke-free in previous quitting attempts, and experiencing nervousness during withdrawal. Receiving physician advice to quit also appears to increase the chance of quitting smoking. Keywords: Smoking; Smoking Cessation; Smoking Cessation Agents; Varenicline; Anxiety; Depression

Availability and content of clinical guidance for tobacco use and dependence treatment – United States, 2000–2019

Evidence-based treatments for tobacco use and dependence can increase cessation success but remain underutilized. Health professional societies and voluntary health organizations (advising organizations) are uniquely positioned to influence the delivery of cessation treatments by providing clinical guidance for healthcare providers. This study aimed to review the guidance produced by these organizations for content and consistency with current evidence.Documents discussing healthcare providers' role in treatment of tobacco use and dependence produced by US-based advising organizations between 2000 and 2019 were identified in both peer-reviewed and grey (i.e., informally or non-commercially published) literature. Extraction of variables, defined in terms of healthcare provider role and endorsement of specific treatment(s), was completed by two independent reviewers.Review of 38 identified documents sponsored by 57 unique advising organizations revealed deficits in the direction of comprehensive care and incorporation of the most recent evidence for treatment of tobacco use and dependence. Documents endorsed: screening (74%), pharmacotherapy (68%), counseling (89%), or follow-up (37%). Few documents endorsed more recent evidence-based treatments including combination nicotine replacement therapy (18%), and text- (11%) and web-based (11%) interventions.Advising organizations have opportunities to address identified gaps and enhance clinical guidance to contribute toward expanding the provision of comprehensive tobacco cessation support.

Impact of a 20-Minute Counselling Session on Smoking Cessation in an Outpatient Clinic; A Cohort Study

Objective: To assess the smoking abstinence rate after a twenty-minutes structured counselling session.&#x0D; Study Design: Prospective Cohort Study.&#x0D; Place and Duration of Study: Respiratory Clinic, Pak Emirates Military Hospital, Rawalpindi Pakistan from Jun to Dec 2020.&#x0D; Methodology: A total of 400 active smokers visiting respiratory clinics were inducted into counselling sessions of twenty-minute duration for a structured smoking cessation counselling advice during which additional information regarding age, motivation status, duration of smoking, previous cessation attempts etc., was also recorded. All candidates were followed by telephone for six months for subject-reported abstinence status.&#x0D; Results: All the study participants were males between 39 to 64 years of age (mean age: 52.27 ± 4.78 years), of which 23 lost to follow-up, 102 (25.5%) remained quitters successfully, while the remaining 305 candidates relapsed at the end of 6 months. The highest relapse was observed at the end of 3 months, while the lowest relapse rate was observed in the fifth and sixth months since the quit date. Younger age had more odds of successful cessation rate than others (OR=6.13 CI 95%, p&lt;0.001). Those with a motivation score of 8 or more had more probability of abstaining (OR=5.38, CI 95%, p-value=0.001)&#x0D; Conclusions: The smoking abstinence rate in these counselling sessions was as significant as in other smoking cessation programs. The probability of quitting was more in younger adults and highly motivated ones.

Successful stopping of biologic therapy for remission in children and young people with juvenile idiopathic arthritis.

Clinicians concerned about long-term safety of biologics in JIA may consider tapering or stopping treatment once remission is achieved despite uncertainty in maintaining drug-free remission. This analysis aims to (i) calculate how many patients with JIA stop biologics for remission, (ii) calculate how many later re-start therapy and after how long, and (iii) identify factors associated with re-starting biologics. Patients starting biologics between 1 January 2010 and 7 September 2021 in the UK JIA Biologics Register were included. Patients stopping biologics for physician-reported remission, those re-starting biologics and factors associated with re-starting, were identified. Multiple imputation accounted for missing data. Of 1451 patients with median follow-up of 2.7 years (IQR 1.4, 4.0), 269 (19%) stopped biologics for remission after a median of 2.2 years (IQR 1.7, 3.0). Of those with follow-up data (N = 220), 118 (54%) later re-started therapy after a median of 4.7 months, with 84% re-starting the same biologic. Patients on any-line tocilizumab (prior to stopping) were less likely to re-start biologics (vs etanercept; odds ratio [OR] 0.3; 95% CI: 0.2, 0.7), while those with a longer disease duration prior to biologics (OR 1.1 per year increase; 95% CI: 1.0, 1.2) or prior uveitis were more likely to re-start biologics (OR 2.5; 95% CI: 1.3, 4.9). This analysis identified factors associated with successful cessation of biologics for remission in JIA as absence of uveitis, prior treatment with tocilizumab and starting biologics earlier in the disease course. Further research is needed to guide clinical recommendations.

Social desirability and under-reporting of smokeless tobacco use among reproductive age women: Evidence from National Family Health Survey

IntroductionThis study hypothesises that the presence of a third person during the interaction between the survey investigator and the woman respondent leads to underreporting of smokeless tobacco (SLT) use by Indian women, including pregnant and breastfeeding women. MethodsCross-sectional data from the National Family Health Survey conducted in 2015–16 was analysed for SLT use among women aged 15–49. Multivariate logistic regression examined the odds of SLT use reporting by women respondents in the presence of their husbands and other male or female adults. ResultsSLT use reporting by women significantly varied by the presence of someone during the interview. The analysis shows that the odds of reporting SLT use among women who were neither pregnant nor lactating was 20.6% lower when they were interviewed in the presence of their husbands than when they were interviewed alone. Similarly, compared to those interviewed alone, the odds of women reporting SLT use was 16.5% lower among pregnant and breastfeeding women interviewed in the presence of any adult female. The odds of women under-reporting SLT use were higher in Central and Western India. ConclusionsThis study argues that the current survey estimates misconstrue the authentic prevalence of tobacco use among women in India, including pregnant and lactating women. Due to social desirability or the presence of a third person during the survey interview, those respondents who do not report their tobacco use status are also more likely to forego essential support for successful tobacco cessation. Survey methodology must be strengthened to avert the presence of a third person during the interview to ensure better reporting and population health estimates.

Smoking cessation intervention prior to orthopedic surgery: A study protocol to determine patient outcomes and feasibility.

The aim of the study is to analyze the effect of smoking and smoking cessation on the incidence of complications among orthopedic and hand surgery patients, and to determine the feasibility of smoking cessation intervention, as well as factors predicting success in smoking cessation. Orthopedic and hand surgery patients will be invited to participate in the study, which will recruit 550 participants (at least 20% daily smokers). A participant will be defined as a daily smoker if he/she reports daily smoking and/or laboratory tests show active smoking. Data will be collected using a self-reported questionnaire and from medical records. Smokers will receive information about the benefits of smoking cessation and will be encouraged to quit. Medication or nicotine replacement therapy will be prescribed. Laboratory tests will be taken two weeks before and two weeks after surgery. Follow-up phone calls will be made at 3, 6, and 12 months after surgery. The primary outcome is any complication, defined as a prolonged stay in hospital or any additional visit to or measure taken by a health service during the 12 months after surgery. Data on complications are mainly obtained from personal health records and from the information received at the follow-up; the rest of the data will be collected from the register of healthcare-associated infections. Secondary outcomes are the number and types of complications. The sample (n=550) was calculated to observe a 10% difference in complications between smokers and non-smokers (5% alpha level and 80% power), considering a 10% drop-out rate. Logistic regression and log-linear models will be used for data analyses.

Managing Opioid Withdrawal in an Outpatient Setting With Lofexidine or Clonidine.

BackgroundThere is a need for improved strategies for managing abrupt opioid withdrawal when transitioning patients with opioid use disorder to comprehensive longitudinal care strategies such as naltrexone maintenance treatment. In addition, alpha-2 adrenergic agonists are used to ameliorate withdrawal symptoms, but current data characterizing real-world treatment are lacking.MethodsA retrospective chart review was conducted in outpatients undergoing abrupt opioid withdrawal managed with lofexidine (0.18 mg, 1-4 tablets 4x daily for 7 days, pro re nata [PRN or as needed]) or clonidine (0.2 mg, 1 tablet 3x daily for 10 days, PRN). Withdrawal outcomes were characterized at 30 days of follow-up. Binomial logistic regression was used to assess a potential association of the two treatments with different likelihoods of opioid cessation success in this real-world outpatient practice.ResultsIn cases treated with lofexidine (n=166) and clonidine (n=432), respectively, 40% and 10% were opioid-free, 6% and 2% continued long-term buprenorphine or methadone, 17% and 36% relapsed, and 37% and 52% were lost to follow-up at 30 days post-withdrawal. Among patients returning for follow-up care, 63% of patients treated with lofexidine and 21% treated with clonidine were opioid-free. Lofexidine was associated with a higher likelihood of opioid cessation success relative to clonidine (OR=6.47; Wald Chi-square=53.79, p<0.001).ConclusionAmong outpatients returning for follow-up care, nearly two-thirds of those managed with lofexidine reached opioid-free status at 30 days post-withdrawal, which was a higher likelihood than those managed with clonidine, thus allowing their transition to comprehensive care, including naltrexone.

Changes in Smoking Cessation–Related Behaviors Among US Adults During the COVID-19 Pandemic

Smoking cessation is an urgent public health priority given that smoking is associated with increased risk of severe COVID-19 outcomes and other diseases. It is unknown how smoking cessation changed nationally during the COVID-19 pandemic. To investigate changes in smoking cessation-related behaviors in the US during the COVID-19 pandemic. This cross-sectional study was conducted using 2011 to 2020 data on 788 008 individuals who had smoked in the past year from the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) survey. Representative retail scanner sales data between January 2017 and July 2021 for 1004 unique nicotine replacement therapy (NRT) universal product codes in 31 US states from NielsenIQ were also used. Calendar year and 4-week sales periods. Changes in annual self-reported prevalence of past-year quit attempts and recent successful cessation before (ie, 2011-2019) and during (ie, 2020) the COVID-19 pandemic and changes in sales volumes in millions of pieces of nicotine gum, lozenge, and patch brands before (1271 four-week sales periods between January 2017 and February 2020) and during (558 four-week sales periods between March 2020 and July 2021) the COVID-19 pandemic were calculated. The 2011 to 2020 pooled BRFSS sample (response rate range, 45.2%-49.9%) included 788 008 respondents (243 061 individuals ages 25-44 years [weighted percentage, 42.5%]; 374 519 men [weighted percentage, 55.7%]). For the first time since 2011, annual past-year quit attempt prevalence decreased between 2019 and 2020, from 65.2% (95% CI, 64.5% to 65.9%) to 63.2% (95% CI, 62.3% to 64.0%), with the largest relative decreases among individuals ages 45 to 64 years (61.4% [95% CI, 60.3% to 62.5%] vs 57.7% [95% CI, 56.3% to 59.2%]), those with 2 or more comorbidities (67.1% [95% CI, 66.0% to 68.2%] to 63.0% [95% CI, 61.6% to 64.4%]), and Black individuals (72.5% [95% CI, 70.3 to 74.6] vs 68.4% [95% CI, 65.3% to 71.3%]). Recent successful cessation remained unchanged during 2019 to 2020. Observed mean (SD) 4-week NRT sales volume in the prepandemic period was 105.6 (66.2) million gum pieces, 51.9 (31.6) million lozenges, and 2.0 (1.1) million patches. Compared with expected sales, observed sales during the COVID-19 pandemic were lower by 13.0% (95% CI, -13.7% to -12.3%) for lozenges, 6.4% (95% CI, -7.3% to -5.5%) for patches, and 1.2% (95% CI, -1.7% to -0.7%) for gum. This study found that serious smoking cessation activity among US adults decreased immediately and remained depressed for more than a year during the COVID-19 pandemic. These findings suggest that smokers experiencing disproportionately negative outcomes during the pandemic should be reengaged and assisted in quit attempts.

Smoking cessation rates in elderly and nonelderly smokers after participating in an intensive care smoking cessation camp.

Since it is a widely known fact that smoking cessation is beneficial physically and cognitively, efforts should be made to enable smokers to quit smoking through policy. Intensive care smoking cessation camps generally show a high smoking cessation success rate, but research is needed to determine which smokers should be admitted due to costeffectiveness. Although many studies have been conducted to find factors related to smoking cessation success, there is still controversy about the will and success rate of smoking cessation of elderly smokers. We performed this study to determine behavior characteristics and smoking cessation success rates in nonelderly and elderly smokers who participated in an intensive care smoking cessation camp.Heavy smokers participating in an intensive care smoking cessation camp at Chonnam National University Hospital between the August 2015 and December 2017 were classified into elderly (age ≥65 years old) or nonelderly (age <65 years old) groups after excluding missing data. Smokers were followed up at 4 weeks, 6 weeks, 12 weeks, and 6 months from the start of abstinence by self-report, measurement of carbon monoxide expiration levels or cotinine testing.A total of 351 smokers were enrolled in the study. At the 6-month follow-up, 56 of 107 (52.3%) elderly smokers and 109 of 244 (44.7%) nonelderly smokers continued to abstain from smoking. Elderly smokers showed a higher smoking cessation rate than that of nonelderly smokers, but it was not statistically significant (OR = 1.36, 95%CI: 0.862, 2.145). The most common causes of cessation failure in both groups were stress and temptation, followed by withdrawal symptoms.Smoking cessation rates in the elderly are comparable to that in the nonelderly after an intensive care smoking cessation camp. Intensive care smoking cessation camps can help both elderly and nonelderly smokers who intend to quit smoking by providing motivation, education and medication. Smoking cessation should be strongly recommended regardless of age.

Methods and factors influencing successful smoking cessation in Thailand: A case-control study among smokers at the community level.

INTRODUCTIONDespite comprehensive tobacco control policies being in place since 1992, smoking prevalence in Thailand has not declined since 2009, indicating a potential need for individual-level measures. This study examined factors influencing successful smoking cessation attempts in Thailand.METHODSWith a case-control design, smoking cessation experiences of 284 successful (defined as having quit smoking for at least six months) and 837 unsuccessful quitters, who were all lifetime daily smokers, were compared, using sociodemographic data, smoking behaviors, and smoking cessation experiences from their last quitting attempt. Data were collected between August and December 2020. Multivariate-adjusted logistic regressions were employed.RESULTSUnaided smoking cessation was the most popular method among Thais attempting to quit smoking; more than 99% of both successful and unsuccessful quitters used this method. A significantly higher proportion of successful quitters favored stopping their smoking abruptly than did unsuccessful quitters. Depending on the cessation phases (nicotine withdrawal or relapse prevention), cessation-supporting factors included a doctor’s recommendation to stop smoking due to smoker’s sickness (OR=2.6; 95% CI: 1.9–3.6), having a grandchild (OR=2.5; 95% CI: 1.1–5.6) or child (OR=2.0; 95% CI: 1.2–3.1), exercising (OR=13.9; 95% CI: 7.2–26.9), avoiding smokers (OR=6.7; 95% CI: 4.1–11.1), self-efficacy (OR=8.5; 95% CI: 3.6–20.0), having a good appetite (OR=1.9; 95% CI: 1.3–2.8), wishing to avoid the unpleasant smell of other people’s smoking after cessation (OR=3.7; 95% CI: 2.5–5.5), smoking prohibitions in public places (OR=2.8; 95% CI: 1.2–6.4) and workplaces (OR=4.5; 95% CI: 1.9–10.3), and expensive tobacco (OR=1.9; 95% CI: 1.3–2.9). Barriers to successful cessation included using roll-your-own (OR=0.4; 95% CI: 0.3–0.5), insomnia (OR=0.3; 95% CI: 0.2–0.5), social pressure to smoke (OR=0.4; 95% CI: 0.3–0.6), associating smoking with a habit/specific activity (OR=0.4; 95% CI: 0.3–0.5), and pleasure of smoking (OR=0.5; 95% CI: 0.3–0.7).CONCLUSIONSThis study highlights several factors found to influence successful smoking cessation among Thai smokers which can be used to design a guideline for unaided smoking cessation, and for smoking cessation enhancement programs and policies.

The Role of Financial Strain and Educational Attainment on Smoking Abstinence of African Americans and Whites Who Smoke.

To examine if reduced financial strain and higher educational attainment would confer less advantage for successful cessation among African Americans than for White individuals. A secondary data analysis of the Quit2Live study, a smoking cessation intervention for individuals who smoke. Recruited participants from a metropolitan city in the Midwest. The sample included 224 African American and 225 White individuals who smoke. Our outcome variable was cotinine-verified smoking abstinence at the end-of-treatment (week 12). Our explanatory variables were a combination of financial strain (high, low) and educational attainment (high, low). We implemented a logistic regression analysis and a two-way interaction of the combined financial strain and educational attainment variable and race on smoking abstinence. About 25% of the study participants were low financial strain and high education, 41% high financial strain and high education, 23% high financial strain and low education, and 11% low financial strain and low education. A greater proportion of African Americans vs Whites were in the high financial strain/low educational attainment category (28% vs 18%, P = .01). Participants with high financial strain and low educational attainment had substantially lower odds of abstinence (OR = .29 [95% CI: .12, .68]) compared to participants with low financial strain and high educational attainment. Contrary to our hypothesis, race did not moderate this association. Findings highlight the constraining role of high financial strain and low educational attainment, irrespective of race, on smoking abstinence among smokers actively engaged in a quit attempt.

Belief and Recall of Nicotine as Therapeutic for COVID-19 May Undermine E-Cigarette Quitting Behavior.

We examine the proposition that misinformation about the therapeutic potential of nicotine to prevent or treat COVID-19 may lead to relapse among attempted e-cigarette quitters. A sample of N = 507 e-cigarette ever-users who reported at least one quit attempt in the past year were surveyed in June of 2021 for recall and belief in several claims about COVID-19 and nicotine. Participants who recalled and believed at least one misinformation claim were significantly more likely to have relapsed than those who did not recall or believe such claims. These differences remained robust to regression analysis adding demographic covariates and accounting for continuous measurement of recall and belief. Misinformation about e-cigarette use is reaching young adult e-cigarette users who are trying to quit. The implications of these findings merit further research to characterize potential barriers to successful e-cigarette cessation.

Overnight Abstinence Is Associated With Smaller Secondary Somatosensory Cortical Volumes and Higher Somatosensory-Motor Cortical Functional Connectivity in Cigarette Smokers.

Abstinence symptoms present challenges to successful cessation of cigarette smoking. Chronic exposure to nicotine and long-term nicotine abstinence are associated with alterations in cortical and subcortical gray matter volumes (GMVs). We aimed at examining changes in regional GMVs following overnight abstinence and how these regional functions relate to abstinence symptoms. Here, in a sample of 31 regular smokers scanned both in a satiety state and after overnight abstinence, we employed voxel-wise morphometry and resting-state functional connectivity (rsFC) to investigate these issues. We processed imaging data with published routines and evaluated the results with a corrected threshold. Smokers showed smaller GMVs of the left ventral hippocampus and right secondary somatosensory cortex (SII) after overnight abstinence as compared to satiety. The GMV alterations in right SII were positively correlated with changes in withdrawal symptom severity between states. Furthermore, right SII rsFC with the precentral gyrus was stronger in abstinence as compared to satiety. The inter-regional rsFC was positively correlated with motor impulsivity and withdrawal symptom severity during abstinence and negatively with craving to smoke during satiety. These findings highlight for the first time the effects of overnight abstinence on cerebral volumetrics and changes in functional connectivity of a higher-order sensory cortex. These changes may dispose smokers to impulsive behaviors and aggravate the urge to smoke at the earliest stage of withdrawal from nicotine. Overnight abstinence leads to changes in gray matter volumes and functional connectivity of the second somatosensory cortex in cigarette smokers. Higher somatosensory and motor cortical connectivity in abstinence is significantly correlated with trait motor impulsivity and withdrawal symptom severity. The findings add to the literature of neural markers of nicotine addiction.

The effects of cognitive and emotional status on smoking cessation.

Smoking cessation is affected by multiple factors including cognitive status of the patients. In this study, we aimed to investigate the effects of demographic, emotional and cognitive functions of 39 male and 42 female patients who applied to the smoking cessation outpatient clinic on smoking cessation. This study recruited 81 healthy volunteers of equal age, gender, and educational level. Total Montreal Cognitive Assessment (MoCA) scores were compared according to age, gender, cessation methods, and Beck Depression Inventory and Beck Anxiety Inventory (BAI) scores in smoking cessation settings. In our study, there were 39 (48.1%) male patients and 42 (51.9%) female patients. While 36 patients were able to quit smoking, the remaining 38 were unable to do so. During follow-up, 7 patients had yet to be reached. Age, years of smoking, number of cigarettes smoked per day, education level, first reason for starting smoking, reasons for quitting smoking, quitting method, and medical drugs used were found to have no effect on smoking cessation; however, the MoCA total score, Beck depression scale, Beck anxiety scale, and smoking cessation scale score were found to have significant effects on smoking cessation. Various cognitive processes, particularly visuospatial and attention skills, have been found to be useful in quitting smoking. Furthermore, emotional states, such as depression and anxiety have a negative impact on quitting smoking. We believe that if it is provided to the patients in the smoking cessation outpatient clinic to boost cognitive capabilities and treat mood problems, the success of smoking cessation will increase.

COVID-19 and hookah smoking cessation among women in Southern Iran: A cross-sectional study

Hookah smoking does not only transmit COVID-19 but also intensifies the symptoms of the disease. Thus, the present research aimed to explore the association between COVID-19 and hookah cessation among female smokers. The institutional-based cross-sectional study was conducted nine months after the onset of the COVID-19 pandemic. Face-to-face interviews were held between November 2020 and January 2021 to explore the pattern of hookah smoking among 561 female hookah smokers in Bandar Abbas in the south of Iran. The daily, weekly and monthly rates of hookah smoking showed a statistically significant decrease in the during COVID-19 era (p < .001). Thirteen percent of women managed to cease hookah smoking successfully during the pandemic. The odds ratio of hookah cessation was higher in single women (95% CI 1.09-5.23) as well as women with a high socioeconomic status (SES) (95% CI 4.28-24.01). It was also higher among women who initiated hookah smoking at an older age (95% CI 29-68) and among those with no hookah smoking family member (95% CI 301- 943). Fear of COVID-19 infection was the leading factor involved in hookah cessation or reduction. Entertainment was the leading barrier to successful hookah cessation behavior. It is believed that COVID-19 has directly and indirectly contributed to the reduced or ceased hookah smoking behavior. One of the reasons for the reduction of hookah smoking was the fear of aggravated symptoms and reasons for cessation included closure of coffee shops and removal of all hookahs from the city.