Provision Of Nicotine Replacement Therapy Research Articles

The role of dentists in nicotine replacement therapy.

Dear Editor, We read the article titled “Nicotine replacement therapy: A friend or foe” with great interest.[1] As authors pointed out smoking is one of the greatest causes of premature death and preventable illness in both developed and developing countries. Health-care professionals, especially dentists, can play an important role in assisting their patients with tobacco cessation.[2] We would like to share few more literature regarding the role of dentists in nicotine replacement therapy (NRT). Though most of the dental curriculums around the world don't have structured modules to train dentists in specific smoking cessation strategies, multiple studies exploring knowledge, attitude, and practice regarding tobacco cessation methods among dental practitioners have provided encouraging insights. Rajput et al. explored the attitudes, practices, and perceived barriers in Tobacco cessation counseling (TCC) among dental practitioners in India and found that seventy-three percent of the dentists agreed that TCC is their responsibility.[3] Moreover, Madhu et al. studied the attitude and practice of the dental students toward tobacco cessation methods using a cross-sectional design and found that almost 50% preferred to recommend nicotine replacement therapies (NRT) as a tobacco cessation advises to the patients.[4] Existing literature supports the fact that dental practitioners have the motivation and knowledge base to support tobacco cessation in their patients. It is the need of the hour for establishing tobacco cessation clinics in dental clinics especially in rural areas where a dentist does the behavioral counseling during which patients are advised to stop the tobacco use, with structured counseling methods.[5] There are no standardized tobacco intervention model for dental care settings. However, the American Dental Hygienists Association recommends a three-steP “AAR” brief tobacco intervention model for dental care settings: Ask every patient about tobacco use, Advise all tobacco users to quit, and Refer tobacco users to nationally available tobacco quitlines via fax or electronic referral.[6] Moreover, dentists can also assess the severity of tobacco addiction using Fagerstrom scale, i.e., the patient is asked a series of 6 questions and scores are given based on the patient's responses and based on the scoring, the patient can be prescribed pharmacotherapy in the form of nicotine replacement therapy (NRT).[5] There are multiple ways in which a dentist can assist their patient with NRT. One potential model for incorporating the provision of NRT in dental practices is NRT sampling (NRTS), in which a short starter course (e.g., 2 weeks) of NRT is given to all medically eligible smokers irrespective of their motivations to quit or seek treatment. Another specific area were dentists can contribute is in modifications NRT practices such as nicotine replacement therapy with tooth-whitening agents. Availability of NRT with stain removal or tooth-whitening activity would provide an opportunity for dentists to illustrate some early measurable benefits of smoking cessation, reinforce smokers’ commitment to quit, and support them on the path to a stable state of not smoking. Dentists can also play a key role in maximizing the benefits of NRT by educating the public regarding the relative safety of NRT when compared to smoking, as most of the studies from around the world indicate that the public incorrectly believes that nicotine is responsible for most of the cancer caused by smoking. Considering the need of the hour and the multiple role a dentist can play in tobacco cessation, the dental councils should consider including tobacco cessation training modules in the curriculum at the BDS level.[5] Furthermore, conferences, workshops, and CDEs regarding tobacco cessation services also should be promoted among dentists to educate and motivate them to start or continue their tobacco cessation services to their patients.[4] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Cost-effectiveness of e-cigarettes compared with nicotine replacement therapy in stop smoking services in England (TEC study): a randomized controlled trial.

AimTo evaluate the cost‐effectiveness of e‐cigarettes as a smoking cessation aid used in routine stop smoking services in England.DesignCost‐effectiveness analysis was performed from the National Health Service (NHS) and Personal Social Services (PSS) perspective for 12‐month periods and life‐time. Costs, including that of both treatments, other smoking cessation help and health‐care services, and health benefits, estimated from EQ‐5D‐5L and measured in quality‐adjusted life‐years (QALYs), for the 12‐month analysis, came from a randomized controlled trial. Life‐time analysis was model‐based with input from both trial data and published secondary data sources. Cost‐effectiveness was measured by an incremental cost‐effectiveness ratio (ICER).SettingThree stop‐smoking service sites in England.ParticipantsAdult smokers (n = 886) who sought help to quit in the participating sites.Intervention and comparatorAn e‐cigarette (EC) starter kit versus provision of nicotine replacement therapy (NRT) for up to 3 months, both with standard behavioural support. A total of 886 participants were randomized (439 in the EC arm, 447 in the NRT arm). Excluding one death in each arm, the 1‐year quit rate was 18.0 and 9.9%, respectively.MeasurementsCost of treatments was estimated from the treatment log. Costs of other smoking cessation help and health‐care services and EQ‐5D‐5 L were collected at baseline, 6‐ and 12‐month follow‐ups. Incremental costs and incremental QALYs were estimated using regression adjusting for baseline covariates and their respective baseline values.FindingsThe ICER was £1100 per QALY gained at the 12 months after quit date (87% probability below £20 000/QALY). Markov model estimated the life‐time ICER of EC to be £65 per QALY (85% probability below £20 000/QALY).ConclusionUsing e‐cigarettes as a smoking cessation aid with standard behavioural support in stop‐smoking services in England is likely to be more cost‐effective than using nicotine replacement therapy in the same setting.

Proactive text messaging (GetReady2Quit) and nicotine replacement therapy to promote smoking cessation among smokers in primary care: A pilot randomized trial protocol

IntroductionMost smokers see a physician each year, but few use any assistance when they try to quit. Text messaging programs improve smoking cessation in community and school settings; however, their efficacy in a primary care setting is unclear. The current trial assesses the feasibility and preliminary clinical outcomes of text messaging and mailed nicotine replacement therapy (NRT) among smokers in primary care. MethodsIn this single-center pilot randomized trial, eligible smokers in primary care are offered brief advice by phone and randomly assigned to one of four interventions: (1) Brief advice only, (2) text messages targeted to primary care patients and tailored to quit readiness, (3) a 2-week supply of nicotine patches and/or lozenges (NRT), and (4) both text messaging and NRT. Randomization is stratified by practice and intention to quit. The text messages (up to 5/day) encourage those not ready to quit to practice a quit attempt, assist those with a quit date through a quit attempt, and promote NRT use. The 2-week supply of NRT is mailed to patients' homes. ResultsFeasibility outcomes include recruitment rates, study retention, and treatment adherence. Clinical outcomes are assessed at 1, 2, 6, and 12-weeks post-enrollment. The primary outcome is ≥1self-reported quit attempt(s). Secondary clinical outcomes include self-reported past 7- and 30-day abstinence, days not smoked, NRT adherence, and exhaled carbon monoxide. ConclusionsThis pilot assesses text messaging plus NRT, as a proactively offered intervention for smoking cessation support in smokers receiving primary care and will inform full-scale randomized trial planning. Trial registrationClinicalTrials.govNCT03174158.

ATLAS OF SEX-SPECIFIC GENETIC CORRELATIONS ACROSS PSYCHIATRY, ANTHROPOMETRY, AND METABOLIC TRAITS

The primary objective is to describe a professional and graduate student–run approach to smoking cessation education combined with motivational interviewing and pharmacotherapy in regard to the frequency of follow-up with a smoking cessation quitline program in the homeless population. The secondary objective is to assess participants’ self-reported level of confidence, knowledge, and willingness to quit before and after participation in the student-run smoking cessation clinic.Homeless shelter in Phoenix, Arizona.A previously established professional and graduate student–led clinic focused on providing a wide variety of free health services to homeless populations at a homeless shelter. One service not offered was smoking cessation support; thus, a student-run smoking cessation clinic was established.Patients were provided smoking cessation education, motivational interviewing, and pharmacotherapy by health sciences professional and graduate students. Patients were then given a 2-week supply of nicotine replacement therapy and referred to the state’s smoking cessation quitline. The impact of multiple concomitant smoking cessation strategies provided by students within a homeless population has not been studied previously.A 10-day post-referral status update on the success of contact with patients was provided to study investigators from the smoking cessation quitline. Surveys were also used to assess the patient’s self-reported level of perceived benefit with the student-run smoking cessation clinic.Of the 139 unique patients, 19 (13.7%) successfully contacted the smoking cessation quitline. Patients reported high baseline confidence, knowledge, and willingness related to quit attempts; they reported a small improvement in reported values after participation in the student-run clinics.In the homeless population, smoking cessation education, motivational interviewing, and pharmacotherapy had a low follow-up frequency with a smoking cessation quitline, but slightly increased the patient’s confidence, knowledge, and willingness to quit.

A systems change intervention for nurse-led smoking cessation care in hospitals

AimThe aim of this study was to determine the feasibility and acceptability of a systems change intervention on nurses’ inpatient management of tobacco dependence. MethodsA mixed methods study involving an uncontrolled pre and post study design and qualitative methods. The systems change intervention consisted of: tobacco use questions within the routine nursing care admission assessment forms; provision of nicotine replacement therapy (NRT) as a ‘nurse-initiated’ medication; and nurse education. A medical record audit was conducted 4 months before and 1 month after implementation to assess recording of: smoking status, offer of NRT and referral to a telephone tobacco cessation counselling service ‘Quitline’. Focus groups and semi-structured interviews were conducted to ascertain acceptability of the systems change intervention. Chi square analysis compared identification of inpatients’ who smoke and offer of NRT pre and post implementation. Constant comparative analysis was used to analyse qualitative data. FindingsNurse recording of inpatient smoking status (83% to 90%) did not significantly improve. However offer of nurse-initiated NRT significantly increased from 0% to 34% (p = 0.02). Acceptance of NRT increased from 50% to 64% (p = 0.055) and offer of referral to Quitline increased (0% to 4%) but increases were not significantly different. Three themes emerged from the qualitative data: Education for the nurses, nurse leadership and therapeutic alliance. ConclusionThe study results show promise as our intervention increased nurses’ offer of NRT for inpatients’ who smoked. New approaches need to be developed to support patients who do not want to or are not ready to quit.

A retrospective analysis of the association between providing nicotine replacement therapy at admission and motivation to quit and nicotine withdrawal symptoms during an inpatient psychiatric hospitalization

BackgroundPsychiatric patients have high tobacco use prevalence, dependence, and withdrawal severity. A tobacco-free psychiatric hospitalization necessitates the management of nicotine withdrawal (NW) for tobacco using patients. NW management often requires the provision of approved nicotine replacement therapy (NRT) to patients, which may also motivate tobacco users towards cessation. However, few studies have examined the associations between providing NRT, motivation to quit, and NW among psychiatric patients. Objective(s)To examine the associations between providing NRT at admission and motivation to quit smoking and severity of NW symptoms. DesignA retrospective review of the medical records of 255 tobacco using patients on whom NW was assessed during their hospital stay. The time when NRT was provided (i.e., at admission vs. not provided vs. on the unit), motivation to quit smoking, and 8-item Minnesota Nicotine Withdrawal Scale were assessed. ResultsThe primary NW symptom was ‘craving’ (65.1%); reporting of ‘anxiety’ varied by psychiatric diagnosis. Providing NRT at admission was not associated with motivation to quit. Patients receiving NRT on the unit (i.e., delayed receipt) had significantly higher NW than those who received NRT at admission. In multivariate analyses, receiving NRT on the unit was significantly associated with greater NW severity (β = .19, p = .002). ConclusionsAmong psychiatric patients, providing NRT at admission is associated with greater severity of NW. The provision of NRT for NW management may be considered as standard practice during tobacco-free psychiatric stays. Future studies may consider the effect of other tobacco treatment medications (such as varenicline, bupropion) on managing NW.

Planning a Change Easily (PACE): A randomized controlled trial for smokers who are not ready to quit

Smoking cessation programs are efficacious and have been validated to assist the 10% to 30% of smokers who are ready to quit in the next 30 days. While the majority of smokers want to quit smoking in the future, only 69% are planning to quit within the next year. Planning a Change Easily (PACE) is a nation-wide, telephone-based comparative effectiveness, randomized controlled trial for smokers not ready to quit (SNRTQ). This project, as well as its intervention components, outcomes, and hypotheses are discussed. This study will compare the effectiveness of four intervention conditions that could potentially help SNRTQ to quit smoking: Brief Advice, Motivational Interviewing, Rate Reduction, and Motivational Interviewing plus Rate Reduction combined. Rate Reduction conditions will include the provision of nicotine replacement therapy in the form of gum. Approximately 840 participants will be recruited and randomized to the four intervention conditions. The main outcomes for this study include self-report prolonged and point prevalence abstinence with biochemical verification of cessation. Secondary outcomes include quit attempts, cost-per-quit, and cost-effectiveness analyses. Informed by evidenced-based interventions, strong clinical guidelines, and economic analysis, PACE has the potential for significant public health impact. Results could readily be disseminated and translated to tobacco quitlines, which are present in all 50 states and are offered free to the public.

Estimates of effectiveness and reach for 'return on investment' modelling of smoking cessation interventions using data from England.

Background and aimsEstimating ‘return on investment’ (ROI) from smoking cessation interventions requires reach and effectiveness parameters for interventions for use in economic models such as the EQUIPT ROI tool (http://roi.equipt.eu). This paper describes the derivation of these parameter estimates for England that can be adapted to create ROI models for use by other countries.MethodsEstimates were derived for interventions in terms of their reach and effectiveness in: (1) promoting quit attempts and (2) improving the success of quit attempts (abstinence for at least 12 months). The sources were systematic reviews of efficacy supplemented by individual effectiveness evaluations and national surveys.FindingsQuit attempt rates were estimated to be increased by the following percentages (with reach in parentheses): 20% by tax increases raising the cost of smoking 5% above the cost of living index (100%); 10% by enforced comprehensive indoor public smoking bans (100%); 3% by mass media campaigns achieving 400 gross rating points (100%); 40% by brief opportunistic physician advice (21%); and 110% by use of a licensed nicotine product to reduce cigarette consumption (12%). Quit success rates were estimated to be increased by the following ratios: 60% by single‐form nicotine replacement therapy (NRT) (5%); 114% by NRT patch plus a faster‐acting NRT (2%);124% by prescribed varenicline (5%); 60% by bupropion (1%); 100% by nortriptyline (0%), 10) 298% by cytisine (0%); 40% by individual face‐to‐face behavioural support (2%); 37% by telephone support (0.5%); 88% by group behavioural support (1%); 63% by text messaging (0.5%); and 19% by printed self‐help materials (1%). There was insufficient evidence to obtain reliable, country‐specific estimates for interventions such as websites, smartphone applications and e‐cigarettes.ConclusionsTax increases, indoor smoking bans, brief opportunistic physician advice and use of nicotine replacement therapy (NRT) for smoking reduction can all increase population quit attempt rates. Quit success rates can be increased by provision of NRT, varenicline, bupropion, nortriptyline, cytisine and behavioural support delivered through a variety of modalities. Parameter estimates for the effectiveness and reach of these interventions can contribute to return on investment estimates in support of national or regional policy decisions.

Impact of large-scale distribution and subsequent use of free nicotine patches on primary care physician interaction

BackgroundLarge-scale distribution efforts of free nicotine replacement therapy (NRT) have been documented to be cost-effective interventions for increasing smoking quit rates. However, despite nearly a dozen studies evaluating their effectiveness, none have examined whether free NRT provision promotes further primary care help-seeking and the impact that it may have on cessation efforts.MethodsIn the context of a randomized controlled trial, a secondary analysis was conducted on 1000 adult regular smokers randomized to be mailed a 5-week supply of nicotine patches or to a no intervention control group. Recipients and users of free nicotine patches at an 8 week follow-up were successfully case matched to controls based on age, gender, baseline level of nicotine dependence and intent to quit (n = 201 per group). Differences in physician interaction between the two groups were evaluated at both 8 week and 6 month follow-ups. The impact of physician interaction on self-reported smoking abstinence at each follow-up was also examined.ResultsAlthough no differences in physician interaction were noted between groups at the 8 week follow-up, at the 6 month follow-up, nicotine patch users reported greater frequency of discussing smoking with their physician (43.9%), as compared to the control group (30.3%) (p = 0.011). Across both groups, over 90% of those that discussed smoking with a physician were encouraged to quit and approximately 70% were provided with additional support. Separate ANOVAs revealed no significant impact of physician interaction on cessation (p > 0.05), regardless of group or follow-up period, however, at the 6 month follow-up, nicotine patch users who discussed cessation with a physician had made serious quit attempts at significantly greater rates (72.6%), compared to controls (49.1%) (p = 0.007).ConclusionsIrrespective of group, the majority of smokers in the present study did not discuss cessation with their physician. Recipients and users of nicotine patches however, were more likely to discuss smoking with their physician, suggesting that the provision of free NRT particularly to those who are likely to use it may facilitate opportunities for benefits beyond the direct pharmacological effects of the medication.Trial registrationclinicaltrials.gov, NCT01429129. Registered: 2 September 2011.

Babies Living Safe & Smokefree: randomized controlled trial of a multilevel multimodal behavioral intervention to reduce low-income children\u2019s tobacco smoke exposure

BackgroundAddressing children’s tobacco smoke exposure (TSE) remains a public health priority. However, there is low uptake and ineffectiveness of treatment, particularly in low-income populations that face numerous challenges to smoking behavior change. A multilevel intervention combining system-level health messaging and advice about TSE delivered at community clinics that disseminate the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), combined with nicotine replacement and intensive multimodal, individual-level behavioral intervention may improve TSE control efforts in such high-risk populations.Methods/DesignThis trial uses a randomized two-group design with three measurement points: baseline, 3-month and 12-month follow-up. The primary outcome is bioverified child TSE; the secondary outcome is bioverified maternal quit status. Smoking mothers of children less than 6 years old are recruited from WIC clinics. All participants receive WIC system-level intervention based on the “Ask, Advise, Refer (AAR)” best practices guidelines for pediatrics clinics. It includes training all WIC staff about the importance of maternal tobacco control; and detailing clinics with AAR intervention prompts in routine work flow to remind WIC nutrition counselors to ask all mothers about child TSE, advise about TSE harms and benefits of protection, and refer smokers to cessation services. After receiving the system intervention, mothers are randomized to receive 3 months of additional treatment or an attention control intervention: (1) The multimodal behavioral intervention (MBI) treatment includes telephone counseling sessions about child TSE reduction and smoking cessation, provision of nicotine replacement therapy, a mobile app to support cessation efforts, and multimedia text messages about TSE and smoking cessation; (2) The attention control intervention offers equivalent contact as the MBI and includes nutrition-focused telephone counseling, mobile app, and multimedia text messages about improving nutrition. The control condition also receives a referral to the state smoking cessation quitline.DiscussionThis study tests an innovative community-based, multilevel and integrated multimodal approach to reducing child TSE in a vulnerable, low-income population. The approach is sustainable and has potential for wide reach because WIC can integrate the tobacco intervention prompts into routine workflow and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines.Trial registrationClinicaltrials.gov NCT02602288. Registered 9 November 2015.

A health sciences student–run smoking cessation clinic experience within a homeless population

ObjectiveThe primary objective is to describe a professional and graduate student–run approach to smoking cessation education combined with motivational interviewing and pharmacotherapy in regard to the frequency of follow-up with a smoking cessation quitline program in the homeless population. The secondary objective is to assess participants’ self-reported level of confidence, knowledge, and willingness to quit before and after participation in the student-run smoking cessation clinic. SettingHomeless shelter in Phoenix, Arizona. Practice DescriptionA previously established professional and graduate student–led clinic focused on providing a wide variety of free health services to homeless populations at a homeless shelter. One service not offered was smoking cessation support; thus, a student-run smoking cessation clinic was established. Practice InnovationPatients were provided smoking cessation education, motivational interviewing, and pharmacotherapy by health sciences professional and graduate students. Patients were then given a 2-week supply of nicotine replacement therapy and referred to the state’s smoking cessation quitline. The impact of multiple concomitant smoking cessation strategies provided by students within a homeless population has not been studied previously. EvaluationA 10-day post-referral status update on the success of contact with patients was provided to study investigators from the smoking cessation quitline. Surveys were also used to assess the patient’s self-reported level of perceived benefit with the student-run smoking cessation clinic. ResultsOf the 139 unique patients, 19 (13.7%) successfully contacted the smoking cessation quitline. Patients reported high baseline confidence, knowledge, and willingness related to quit attempts; they reported a small improvement in reported values after participation in the student-run clinics. ConclusionIn the homeless population, smoking cessation education, motivational interviewing, and pharmacotherapy had a low follow-up frequency with a smoking cessation quitline, but slightly increased the patient’s confidence, knowledge, and willingness to quit.

Tobacco User Characteristics and Outcomes Related to Intensity of Quitline Program Use: Results From Minnesota and Pennsylvania.

Tobacco users in all 50 states have access to quitline telephone counseling and cessation medications. While studies show multiple calls relate to quit success, most participants do not complete a full call series. To date, quitline program use studies have analyzed single factors-such as number of calls or counseling minutes. This study combines multiple factors of quitline program use across 2 states to describe how participants use a 5-call program; assess whether intensity of program use is associated with participant subgroups; and assess whether key outcomes (quitting, satisfaction) are associated with intensity. This observational study examines data for quitline participants in Minnesota (n = 2844) and Pennsylvania (n = 14 359) in 2011 and 2012. A subset of participants was surveyed 7 months after registration to assess key outcomes (response rates: Minnesota 65%; Pennsylvania 60%). Quitline utilization data were used to identify program use variables: nicotine replacement therapy provision, number of counseling calls, number of counseling minutes, days from first to last counseling call, and days from registration to first counseling call. Ten program use groups were created using all 5 program use variables, from lowest (1) to highest (10) intensity. Results were similar for both states. Only 11% of Minnesota and 8% of Pennsylvania participants completed all 5 calls. Intensity of quitline program use was associated with several participant characteristics including health conditions and age. Both quit status and program satisfaction were associated with program use intensity. Quit rates peaked in group 9, participants who received the full 5-call program. Quitlines should focus on engaging participants in multiple calls to improve quit outcomes. In addition, it is important to leverage multiple program use factors for a fuller understanding of how quitline participants use a program.

Nicotine Replacement Therapy Use Predicts Smoking and Drinking Outcomes among Heavy-Drinking Smokers Calling a Tobacco Quitline.

Suboptimal use of nicotine replacement therapy (NRT) may pose a significant barrier to smokers attempting to quit. We examined NRT use as a predictor of smoking abstinence and heavy drinking in a randomised trial of hazardous drinkers who contacted the NY State Smokers' quitline for smoking cessation assistance. Participants (N = 1,948) received either Tobacco Only Counselling or Alcohol + Tobacco Counselling (ATC), both in addition to a 2-week supply of NRT. NRT use, smoking status, and heavy drinking days were assessed by self-report at the 7-month follow-up. Of those smokers who completed the 7-month follow-up (N = 843), 53.1% used all of the NRT and 40.6% used some. Those who used all of the NRT were more likely to be abstinent from smoking than those who used some, and more likely to report no heavy drinking days than those who used some or none. Approximately half of the heavy drinking smokers calling the quitline are willing to use the 2-week supply of free NRT, and most will at least try it. Those who reported using all of the NRT were more likely to report smoking abstinence and no heavy drinking days at the 7-month follow-up.

Randomized Controlled Trial of a Healthy Lifestyle Intervention Among Smokers With Psychotic Disorders.

People with severe mental disorders typically experience a range of health problems; consequently, interventions addressing multiple health behaviors may provide an efficient way to tackle this major public health issue. This two-arm randomized controlled trial among people with psychotic disorders examined the efficacy of nicotine replacement therapy (NRT) plus either a face-to-face or predominantly telephone delivered intervention for smoking cessation and cardiovascular disease (CVD) risk reduction. Following baseline assessment and completion of a common, individually delivered 90-minute face-to-face intervention, participants (n = 235) were randomized to receive NRT plus: (1) a "Healthy Lifestyles" intervention for smoking cessation and CVD risk behaviors or (2) a predominantly telephone-based intervention (designed to control for NRT provision, session frequency, and other monitoring activities). Research assistants blind to treatment allocation performed assessments at 15 weeks (mid-intervention) and 12 months after baseline. There were no significant differences between intervention conditions in CVD risk or smoking outcomes at 15 weeks or 12 months, with improvements in both conditions (eg, 12 months: 6.4% confirmed point prevalence abstinence rate; 17% experiencing a 50% or greater smoking reduction; mean reduction of 8.6 cigarettes per day; mean improvement in functioning of 9.8 points). The health disparity experienced by people with psychotic disorders is high. Face-to-face Healthy Lifestyle interventions appear to be feasible and somewhat effective. However, given the accessibility of telephone delivered interventions, potentially combined with lower cost, further studies are needed to evaluate telephone delivered smoking cessation and lifestyle interventions for people with psychotic disorders.

Observation of the extent of smoking in a mental health inpatient facility with a smoke-free policy.

BackgroundPeople with a mental illness experience a higher burden of smoking-related disease. Smoke-free policies in mental health facilities provide an opportunity to reduce smoking-related harms for patients and staff alike. Limited evidence regarding the effect of such policies on preventing smoking in mental health facilities has been reported. The aims of this study are to describe the extent of smoking and the provision of nicotine replacement therapy (NRT) to patients in a mental health facility with a smoke-free policy.MethodsCross-sectional studies of smoking (cigarette butt count and observed smoking) and nicotine dependence treatment (patient record audit) were undertaken over 9 consecutive weekdays in one mental health facility in Australia. A smoke-free policy incorporating a total smoking ban and guidelines for treating nicotine dependence among patients was implemented in the facility 4 years prior to the study.ResultsTwo thousand one hundred and thirty seven cigarette butts were collected and 152 occasions of people smoking were observed. Staff members were observed to enforce the policy on 66% of occasions. Use of NRT was recorded for 53% of patients who were smokers.ConclusionImplementation of the smoke-free policy was less than optimal and as a consequence ineffective in eliminating smoking and in optimising the provision of NRT. Additional strategies to improve the provision of nicotine dependence treatment to patients and the monitoring of adherence are needed to ensure the intended benefits of smoke-free policies are realised.

Clinical management of tobacco dependence in inpatient psychiatry: provider practices and patient utilization.

This investigation examined predictors of utilization of nicotine replacement therapy (NRT) during a smoke-free psychiatric hospitalization. Smokers (N=324) were recruited from smoke-free adult inpatient psychiatric units. Exploratory analyses examined correlates of NRT provision and utilization. The prevalence of NRT use was 51% overall and was greater among patients offered NRT on admission (58%) versus later (34%), among patients with more severe depression and nicotine withdrawal, and among those who reported perceptions that NRT decreases nicotine withdrawal, provides a nicotine substitute, and helps with quitting smoking (p<.05, all comparisons). Although the ratio of nicotine patch dose to usual cigarettes per day was 1.2±.7, the ratio was negatively correlated with time to first cigarette (Spearman's ρ=-.30, p<.01), suggesting potential underdosing of more dependent smokers. During smoke-free psychiatric hospitalizations, clinical management of nicotine withdrawal may be enhanced by offering patients NRT directly on admission, educating patients on the benefits of NRT, and increasing the dosage for more dependent smokers.

Pediatric Emergency Department Is a Promising Venue for Adult Tobacco Cessation Interventions

Pediatric Emergency Department Is a Promising Venue for Adult Tobacco Cessation Interventions

A randomized controlled trial of a smoking cessation intervention conducted among prisoners.

AimTo evaluate the efficacy of nortriptyline (NOR) added to a multi-component smoking cessation intervention, which included cognitive–behavioural therapy (CBT) and provision of nicotine replacement therapy (NRT).DesignRandomized controlled trial (RCT) comparing two study groups with blinded follow-up at 3, 6 and 12 months. Both groups received a multi-component smoking cessation intervention comprising two half-hour individual sessions of CBT and NRT with either active NOR or placebo.SettingPrisons in New South Wales (17) and Queensland (one), Australia.ParticipantsA total of 425 male prisoners met inclusion criteria and were allocated to either treatment (n = 206) or control group (n = 219).MeasurementsPrimary end-points at 3, 6 and 12 months were continuous abstinence, point prevalence abstinence and reporting a 50% reduction in smoking. Smoking status was confirmed by expired carbon monoxide, using a cut-point of ≤10 parts per million.FindingsParticipants' demographics and baseline tobacco use were similar in treatment and control groups. Based on an intention-to-treat analysis, continuous abstinence between the treatment and control groups was not significantly different at 3 months (23.8 versus 16.4%), 6 months (17.5 versus 12.3%) and 12 months (11.7 versus 11.9%).ConclusionAdding nortriptyline to a smoking cessation treatment package consisting of behavioural support and nicotine replacement therapy does not appear to improve long-term abstinence rates in male prisoners.

A randomized controlled trial of a tailored group smoking cessation intervention for HIV-infected smokers.

More than half of the persons living with human immunodeficiency virus (HIV; PLWH) in the US smoke cigarettes, and tobacco use is responsible for considerable morbidity and mortality in this group. Little is known about the efficacy of tobacco treatment strategies in PLWH. Randomized controlled trial comparing Positively Smoke Free (PSF), an intensive group-therapy intervention targeting HIV-infected smokers, to standard care. A cohort of 145 PLWH smokers, recruited from an HIV-care center in the Bronx, New York, were randomized 1:1 into the PSF program or standard care. All were offered a 3-month supply of nicotine replacement therapy. PSF is an 8-session program tailored to address the needs and concerns of HIV-infected smokers. The sessions were cofacilitated by a graduate student and an HIV-infected peer. The primary outcome was biochemically confirmed, 7-day point-prevalence abstinence at 3 months. In the intention-to-treat analysis, PSF condition subjects had nearly double the quit rate of controls (19.2% vs. 9.7%, P = 0.11). In the complete case, as-treated analysis, assignment to PSF was associated with increased odds of quitting (odds ratio(adj) 3.55, 95% confidence interval 1.04 to 12.0). Latino ethnicity and lower loneliness score were predictive of abstinence. The subjects in the PSF condition exhibited significant decreases in daily cigarette consumption and significant increases in self-efficacy and in motivation to quit. Attendance of ≥7 sessions was associated with higher quit rates. These findings suggest a positive effect of PSF on cessation rates in PLWH smokers. Loneliness and self-efficacy are influential factors in the smoking behaviors of PLWH.

Integrating Tobacco Cessation Quitlines Into Health Care: Massachusetts, 2002–2011

QuitWorks is a Massachusetts referral program that links health care organizations, providers, and patients to the state’s tobacco cessation quitline and provides feedback reporting. Designed collaboratively with all major Massachusetts health plans, QuitWorks was launched in April 2002. In 2010, approximately 340 institutions and practices used QuitWorks. Between April 2002 and March 2011, approximately 3,000 unique providers referred patients and 32,967 tobacco users received referrals. An analysis of QuitWorks data showed 3 phases in referrals between April 2002 and March 2011: referrals increased from April 2002 through November 2005, plateaued during December 2005 through January 2009, then substantially increased during February 2009 through March 2011. Factors responsible include partnerships with stakeholders, periodic program promotions, hospital activities in response to Joint Commission tobacco use measures, service evolutions, provision of nicotine replacement therapy for referred patients, and electronic referral options. QuitWorks’ history demonstrates that tobacco cessation referral programs can be successfully sustained over time; reach substantial numbers of tobacco users, benefit providers and health care organizations; and contribute to sustainable systems-level changes in health care.