Smoking Cessation Support Research Articles

Outback Quit Pack: Feasibility trial of outreach smoking cessation for people in rural, regional, and remote Australia.

Tobacco smoking rates are higher in rural, regional, and remote (RRR) areas in Australia, and strategies to improve access to quit supports are required. This pilot study examined the feasibility of a smoking cessation intervention for people in RRR areas who smoke with the intention of using this data to design a powered effectiveness trial. A randomised controlled trial (RCT) of the feasibility of a 12-week 'Outback Quit Pack' intervention consisting of mailout combination nicotine replacement therapy (NRT) and a proactive referral to Quitline, compared with a minimal support control (1-page smoking cessation support information mailout) was conducted between January and October 2021. Participants recruited via mailed invitation or Facebook advertising, were adults who smoked tobacco (≥10 cigarettes/day) and resided in RRR areas of New South Wales, Australia. Participants completed baseline and 12-week follow-up telephone surveys. Outcomes were feasibility of trial procedures (recruitment method; retention; biochemical verification) and acceptability of intervention (engagement with Quitline; uptake and use of NRT). Facebook advertising accounted for 97% of participant expressions of interest in the study (N = 100). Retention was similarly high among intervention (39/51) and control (36/49) participants. The intervention was highly acceptable: 80% of the intervention group had ≥1 completed call with Quitline, whilst Quitline made 3.7 outbound calls/participant (mean 14:05 mins duration). Most of the intervention group requested NRT refills (78%). No differences between groups in self-reported cessation outcomes. Biochemical verification using expired air breath testing was not feasible in this study. The Outback Quit Pack intervention was feasible and acceptable. Alternative methods for remote biochemical verification need further study. SO WHAT?: A powered RCT to test the effectiveness of the intervention to improve access to evidence-based smoking cessation support to people residing in RRR areas is warranted.

Current Practices, Perceived Barriers, and Promising Implementation Strategies for Improving Quality of Smoking Cessation Support in Accredited Cancer Programs of the American College of Surgeons.

Persistent smoking is associated with poor outcomes in cancer care. It is strongly recommended that oncology care providers provide cessation support; however, there is limited information about smoking cessation assessment and treatment patterns in routine oncology practice. Leaders of the American College of Surgeons Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (National Accredited Program for Breast Cancer) elected to participate in a national quality improvement initiative (Just ASK) focused on smoking assessment/treatment in cancer care. Online baseline survey responses were received from 762 accredited programs. Most programs reported regularly asking about smoking (89.9%), documenting smoking history and current use (85.8%), and advising patients to quit (71.2%). However, less than half of programs reported documenting a smoking cessation treatment plan (41.7%). Even fewer programs reported regularly assisting patients with quitting (41.3%), providing self-help information (27.2%), providing individual counseling (18.2%), and referring patients to an affiliated tobacco treatment program (26.1%) or external Quitline (28.5%). Very few programs reported regularly prescribing medications (17.6%). Principal barriers to tobacco treatment delivery were lack of staff training (68.8%), lack of designated specialists (61.9%), perceived patient resistance (58.3%), lack of available resources (53.3%), competing clinical priorities (50.9%), inadequate program funding (40.6%), insufficient staff time (42.4%), and inadequate reimbursement (31.0%). Although programs reported a high rate of smoking assessment, critical gaps in advising and assisting patients with cessation were found. Improving equitable delivery of smoking assessment/treatment in cancer care will require addressing key organizational and provider barriers for implementation of best practices.

Transcranial direct current stimulation combined with a brief intervention for smoking cessation: a randomized double-blind clinical trial.

Non-invasive brain stimulation methods are currently being evaluated for treatment of addictive disorders. Some evidence indicates that modulating left and right prefrontal brain activity by transcranial direct current stimulation (tDCS) can reduce craving and relapse rates in tobacco addiction. Therefore, this study investigated the effects of active and sham tDCS as an add-on treatment to a standardized brief intervention for smoking cessation. This randomized, double-blind study included 36 participants (22 women and 14 men) with nicotine dependence according to ICD-10 criteria. At five visits on alternate days, participants underwent a 20-min active or sham tDCS over the left dorsolateral prefrontal cortex and subsequently participated in a 10-min brief intervention for smoking cessation. Patients were followed up after 3months. On each treatment day and at follow-up, abstinence was assessed as the smoking status nonsmoker and craving was assessed with the German version of the Questionnaire on Smoking Urges. At each visit, the number of cigarettes smoked per day was recorded and carbon monoxide in expired air and cotinine in saliva were measured. At follow-up, a study-specific questionnaire was used to assess tobacco use. All 36 participants completed the treatment sessions, but one participant in each group was lost to follow-up. Abstinence rates were not significantly different between the groups at any of the study visits, but craving was significantly lower in the active group at tDCS session 5 compared with session 1. tDCS combined with a brief intervention may support smoking cessation, but studies need to evaluate whether longer and more intensive treatment can achieve significant, sustainable effects.

Environment and social support for smoking cessation among community smokers in Beijing, China

Environment and social support for smoking cessation among community smokers in Beijing, China

Introducing Quin: The Design and Development of a Prototype Chatbot to Support Smoking Cessation.

Chatbots emulate human-like interactions and may usefully provide on-demand access to tailored smoking cessation support. We have developed a prototype smartphone application-based smoking cessation chatbot, named Quin, grounded in real-world, evidence-, and theory-based smoking cessation counseling sessions. Conversation topics and interactions in Quitline counseling sessions (N = 30; 18 h) were characterized using thematic, content, and proponent analyses of transcripts. Quin was created by programming this content using a chatbot framework which interacts with users via speech to text. Reiterative changes and additions were made to the conversation structure and dialogue following regular consultation with a multidisciplinary team from relevant fields, and from evidence-based resources. Chatbot conversations were encoded into initial and scheduled follow-up "appointments." Collection of demographic information, and smoking and quit history, informed tailored discussion about pharmacotherapy preferences, behavioral strategies, and social and professional support to form a quit plan. Follow-up appointments were programmed to check in on user progress, review elements of the quit plan, answer questions, and solve issues. Quin was programmed to include teachable moments and educational content to enhance health literacy and informed decision-making. Personal agency is encouraged through exploration and self-reflection of users' personal behaviors, experiences, preferences, and ideas. Quin's successful development represents a movement toward improving access to personalized smoking cessation support. Qualitative foundations of Quin provide greater insight into the smoking cessation counseling relationship and enhances the conversational ability of the technology. The prototype chatbot will be refined through beta-testing with end users and stakeholders prior to evaluation in a clinical trial. Our novel study provides transparent description of the translation of qualitative evidence of real-world smoking cessation counseling sessions into the design and development of a prototype smoking cessation chatbot. The successful iterative development of Quin not only embodies the science and art of health promotion, but also a step forward in expanding the reach of tailored, evidence based, in-pocket support for people who want to quit smoking.

P1.01-12 “A Core Part of the Whole Thing...”: Stakeholder Views on Offering Smoking Cessation Support in Lung Cancer Screening

P1.01-12 “A Core Part of the Whole Thing...”: Stakeholder Views on Offering Smoking Cessation Support in Lung Cancer Screening

Immediate smoking cessation support during lung cancer screening: long-term outcomes from two randomised controlled trials

BackgroundImmediate smoking cessation interventions delivered alongside targeted lung health checks (TLHCs) to screen for lung cancer increase self-reported abstinence at 3 months. The impact on longer term, objectively confirmed quit...

Impact of implementation of a smoking prevention intervention on vocational students’ smoking status

Abstract Introduction Smoking prevalence is high in vocational education across Europe. School-based programs to reduce smoking among older adolescents and young adults are sparse. School tobacco policies are often used though the evidence for their effectiveness is inconclusive. The implementation process of far-reaching smoking prevention initiatives such as tobacco policies can be challenging due to, e.g., nicotine dependency and attitudes towards smoking. We investigated the association between implementation of a smoking prevention intervention and students’ smoking status. Methods The “Focus” intervention combined a comprehensive school tobacco policy with educational activities and access to smoking cessation support. It was tested in a cluster-randomized controlled trial in 14 Danish vocational schools. Based on a conceptual model, we calculated an individual level implementation score for all students in the intervention arm, including schools’ delivery (principal and teacher surveys) and students’ receipt (student surveys) of the intervention components at 4-5 month-follow-up. We compared odds for smoking daily or weekly (regular smoking) for students with low, medium, and high implementation with students in control schools using multilevel logistic regression models (N = 1112). Results Students with high implementation had significantly lower odds for smoking compared to the control group (OR: 0.37, 95% CI: 0.18-0.78) whereas students with medium (OR: 1.72, 95% CI: 0.95-3.12) and low (OR: 1.26, 95% CI: 0.68-2.34) implementation had higher odds, although insignificant. Conclusions High implementation of the “Focus” intervention was associated with less smoking. Tendencies in the opposite direction for lower implementation may indicate a complex, non-linear relationship between implementation level and smoking behavior. This suggests that careful implementation efforts are needed to reduce smoking in older adolescent and young adult school settings. Key messages • Our study suggests that efforts to support implementation of smoking prevention interventions are needed to reduce smoking in vocational education and similar settings. • To capture the complexity of the implementation process, we use an individual level measure of implementation based on a conceptual model and multiple data sources.

Smoking Cessation Counseling in Practice: A Qualitative Analysis of Quitline Conversations in Queensland, Australia.

Telephone-based services are a practical and effective behavioral support for smoking cessation, yet no in-depth analyses of this counseling have been conducted. Understanding the general content of Quitline conversations can help to improve current practices and may inform future interventions. Therefore, we aimed to independently explore conversation themes, topics, and client questions during Quitline counseling sessions with Quitline clients in Queensland, Australia. A purposive sample of 30 recorded counseling sessions, completed between January and March 2019, were de-identified, transcribed, and thematically analyzed. Seven themes, encompassing 35 topics, were derived from 26 initial calls and four follow-up calls: (1) Client details and building rapport; (2) Client history and motivation to quit; (3) Pharmacotherapy; (4) Behavioral aspects of quitting and relationship with smoking; (5) Understanding nicotine dependence and other important considerations; (6) Additional support and smoking cessation resources; and (7) Planning, goal setting and follow-up. Three themes emerged from 18 client questions including (1) Pharmacotherapy safety and contraindications; (2) Pharmacotherapy instructions and mechanism of action; and (3) Physiology of nicotine dependence. This is the first qualitative analysis of the content of Quitline counseling sessions in Australia. Counselors collect and deliver a breadth of information to provide tailored, evidence-based health care, while building rapport and trust. Findings may be translatable into personalized self-help interventions that are more accessible or appealing to people reluctant to contact Quitline. Harnessing educational opportunities regarding pharmacotherapy adherence and misconceptions can improve client confidence in the product and smoking cessation outcomes. Further research will map conversations to motivational interviewing and behavior change techniques.

Study on the participation of nursing staff in tobacco cessation support and related influencing factors: A survey from Chongqing, China.

Nursing staff's assistance for smokers to quit smoking can increase the rate of quitting. The smoking cessation help can be affected by many factors. This study surveyed the use of the 5As (Asking, Advising, Assessing, Assisting, Arranging) approach to support smoking cessation by the nursing staff in Chongqing, China, and analyzed the corresponding influencing factors. A stratified random cluster sampling method was used to select nursing staff from 8 tertiary hospitals, 5 secondary hospitals, 12 community health centers, and 35 township health centers in different geographical regions of Chongqing. A questionnaire survey was conducted among the nursing staff to investigate their participation in smoking cessation. Binary logistic regression analysis was employed to analyze the influencing factors of smoking cessation 5As behavior of the nursing staff. The 1669 participants were 44 males (2.6%) and 1625 females (97.4%), with an average age of 37.00 ± 10.89 years. Among the participants, 55.2% were from tertiary hospitals, 23.2% from secondary hospitals, 14.2% from township health centers, and 7.4 from community health centers. The often or always used behaviors were: Asking, 69.2%; Advising, 53.0%; Assessing, 39.5%; Assisting, 33.7%; and Arranging, 25.1%. The factors that affected all the 5As were: smoking cessation training (AOR=1.60; 95% CI: 1.22-2.11), knowledge of smoking cessation guidelines (AOR=1.75; 95% CI: 1.32-2.32) and the use of smoking cessation Apps (AOR=1.50; 95% CI: 1.09-2.06), and smokers' willingness to quit (AOR=2.20; 95% CI: 1.60-3.02). Smoker's motivation to quit smoking and nurses' knowledge of tobacco cessation resources affected nurses' participation in smoking control behavior. While encouraging smokers to quit smoking, clinical nursing staff should be provided with related resources to advocate smoking cessation. Guided by the Chinese Clinical Tobacco Cessation Guidelines, smoking control knowledge and skills training should be provided for nursing staff to increase their positive attitude towards smoking control, so as to promote their active participation.

A cost-effectiveness analysis of national smoking cessation services among chronic obstructive pulmonary disease patients in Thailand

AimsThailand’s national smoking cessation services (FAH-SAI clinics) were founded in 2010. A cost-effectiveness analysis (CEA) is needed to inform policymakers of the allocation and prioritization of the limited budget to maximize the value for money of reimbursing these services. Chronic obstructive pulmonary disease (COPD) patients would benefit from smoking cessation services. Therefore, this study aimed to assess the cost-effectiveness of these multidisciplinary services compared to the usual care among COPD patients in Thailand from a societal perspective.MethodsWe conducted a CEA from a societal perspective using a Markov model to simulate lifetime costs and quality-adjusted life years (QALYs) gained by each smoking cessation intervention over the patient’s lifetime. We derived the effectiveness of the smoking cessation services from a multicenter, longitudinal study of smoking cessation services in Thailand and estimated the natural quit rate, transition probabilities, health utility, and cost data from the published literature. Costs and outcomes were discounted at 3%. Sensitivity analyses were performed.ResultsCompared to the usual care, FAH-SAI clinics were associated with higher costs (4,207 THB (US$133)) and improved QALYs (0.11), with an incremental cost-effectiveness ratio of 37,675 THB/QALY (US$1,187/QALY). The effectiveness of FAH-SAI clinics was a key driver of the cost-effectiveness results. At the willingness-to-pay (WTP) threshold of 160,000 THB (US$5,042) per QALY gained, the probability of being cost-effective was 96.5%.ConclusionsFAH-SAI clinics were cost-effective under Thailand’s WTP threshold. Our results could inform policymakers in allocating resources to support smoking cessation services for COPD patients in Thailand.

The history of smoking cessation support in Hungary

The history of smoking cessation support in Hungary

Smartphone App-Based Interventions to Support Smoking Cessation in Smokers with Mental Health Conditions: A Systematic Review

Background—Despite global efforts to control tobacco use, smoking remains a leading cause of preventable diseases, mortality, and disparities, especially among individuals with mental health conditions. Smartphone apps have emerged as cost-effective tools to aid smokers in quitting; however, their evidence-based foundation remains understudied. This research conducted two searches to identify relevant apps: one through the scientific literature and the other from app stores. Methods—The study sought apps designed to assist smokers with mental health conditions in quitting. Searches were conducted in the scientific literature and major app stores. The apps found were evaluated for their basis in theory, features, and claimed effectiveness. Usage and rating scores were compared. Results—Among 23 apps found from app store search, only 10 (43%) were evidence-based and none had explicit reference to theory, while all apps identified in the literature were developed by applying theory. However, app store apps had significantly higher user numbers and ratings than those identified in the literature (mean rating 4.7 out of 5.0). Conclusion—Smokers with mental health conditions have limited support from currently available smoking cessation apps. Apps identified in the scientific literature lack sufficient use and longevity. Sustained support beyond research projects is crucial for enabling theoretically informed evidence-based apps to be available for people with mental health conditions, as is greater collaboration between developers and researchers to create apps that engage with end-user design.

The effect of neighborhood socioeconomic disadvantage on smoking status, quit attempts, and receipt of cessation support among adults with cancer: Results from nine ECOG-ACRIN Cancer Research Group trials.

Tobacco use is associated with adverse outcomes among patients diagnosed with cancer. Socioeconomic determinants influence access and utilization of tobacco treatment; little is known about the relationship between neighborhood socioeconomic disadvantage (NSD) and tobacco assessment, assistance, and cessation among patients diagnosed with cancer. A modified Cancer Patient Tobacco Use Questionnaire (C-TUQ) was administered to patients enrolled in nine ECOG-ACRIN clinical trials. We examined associations of NSD with (1) smoking status, (2) receiving tobacco cessation assessment and support, and (3) cessation behaviors. NSD was classified by tertiles of the Area Deprivation Index. Associations between NSD and tobacco variables were evaluated using logistic regression. A total of 740 patients completing the C-TUQ were 70% male, 94% White, 3% Hispanic, mean age 58.8years. Cancer diagnoses included leukemia 263 (36%), lymphoma 141 (19%), prostate 131 (18%), breast 79 (11%), melanoma 69 (9%), myeloma 53 (7%), and head and neck 4 (0.5%). A total of 402 (54%) never smoked, 257 (35%) had formerly smoked, and 81 (11%) were currently smoking. Patients in high disadvantaged neighborhoods were approximately four times more likely to report current smoking (odds ratio [OR],3.57; 95% CI, 1.69-7.54; p=.0009), and more likely to report being asked about smoking (OR,4.24; 95% CI, 1.64-10.98; p=.0029), but less likely to report receiving counseling (OR,0.11; 95% CI, 0.02-0.58; p=.0086) versus those in the least disadvantaged neighborhoods. Greater neighborhood socioeconomic disadvantage was associated with smoking but less cessation support. Increased cessation support in cancer care is needed, particularly for patients from disadvantaged neighborhoods.

Specialist cancer hospital-based smoking cessation service provision in Ireland

BackgroundWhile much progress has been made in reducing tobacco use in many countries, both active and passive smoking remain challenges. The benefits of smoking cessation are universally recognized, and the hospital setting is an ideal setting where smokers can access smoking cessation services as hospital admission can be a cue to action. Consistent delivery of good quality smoking cessation care across health services is an important focus for reducing the harm of tobacco use, especially among continued smokers.AimsOur objective was to document the smoking cessation medication and support services provided by specialist adult cancer hospitals across Ireland, a country with a stated tobacco endgame goal.MethodsA cross-sectional survey based on recent national clinical guidelines was used to determine smoking cessation care delivery across eight specialist adult cancer tertiary referral university hospitals and one specialist radiotherapy center. Survey responses were collected using Qualtrics, a secure online survey software tool. The data was grouped, anonymized, and analyzed in Microsoft Excel.ResultsAll responding hospitals demonstrated either some level of smoking cessation information or a service available to patients. However, there is substantial variation in the type and level of smoking cessation information offered, making access to smoking cessation services inconsistent and inequitable.ConclusionThe recently launched National Clinical Guideline for smoking cessation provides the template for all hospitals to ensure health services are in a position to contribute to Ireland’s tobacco endgame goal.

Adverse physiological effects of smoking cessation on the gastrointestinal tract: A review.

Smoking cessation is known to have numerous health benefits, but it can also induce adverse physiological effects, including those affecting the gastrointestinal tract (GIT). Understanding the adverse physiological effects of smoking cessation on the GIT is critical for healthcare professionals and smokers attempting to quit, as it enables them to anticipate and manage potential challenges during the smoking cessation process. Although the detrimental effects of smoking on the GIT have been well established, there is a gap in the literature regarding the specific physiological reactions that may occur upon smoking cessation. This mini-review summarizes the current literature on the predisposing factors, pathophysiology, clinical presentation, and treatment options for adverse physiological effects of smoking cessation on the GIT. We aimed to raise awareness among busy clinical professionals about these adverse effects, empowering them to effectively support individuals striving to quit smoking and maintain their cessation. By consolidating the existing knowledge in this field, this review offers practical implications for smokers, healthcare providers, and policymakers to optimize smoking cessation interventions and support strategies to improve health outcomes.

Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses.

Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses.

Evaluating the implementation of adult smoking cessation programs in community settings: Protocol for a scoping review

Background Morbidity and mortality due to tobacco smoking is a public health crisis predicted to rise in coming years with the growing global population. Smoking cessation programs are an important tool to support service users to quit smoking. Understanding implementation processes and associated contextual factors influencing uptake of smoking cessation programs may help enhance service delivery, service user engagement, and cessation outcomes. Objectives The objective of this review is to evaluate the implementation of smoking cessation programs for adult smokers aged 18 years or older. Rationale Whilst the effectiveness of smoking cessation programs has been thoroughly investigated, there is limited research examining the implementation of programs in practice. This scoping review will provide novel information by evaluating the implementation of smoking cessation programs including acceptability, fidelity, scalability, and sustainability. Inclusion criteria This review will include the implementation of smoking cessation programs for adults aged 18 years or older, who are daily smokers of tobacco-based cigarettes, accessing a community-based service for smoking cessation support. Methods A search of research databases Medline, CENTRAL, Embase, and Web of Science will be undertaken, in addition to searching for grey literature for potential studies for inclusion. Hand searches of included articles will also be performed. Data will be extracted into a spreadsheet and ordered into predetermined categories based on the inclusion criteria, intervention, implementation strategies and implementation outcomes. Implementation outcomes including acceptability, cost, and scalability will provide the framework for reporting outcomes. Conclusions This scoping review will evaluate the implementation of smoking cessation services to adults in the community. An evidence map highlighting current knowledge will be developed, contributing to the body of literature on community-based smoking cessation programs. Evidence gaps will be identified, providing direction for future research and service delivery internationally.

Study protocol of an economic evaluation embedded in the Midwives and Obstetricians Helping Mothers to Quit Smoking (MOHMQuit) trial

BackgroundTobacco smoking during pregnancy is the most important preventable risk factor for pregnancy complications and adverse birth outcomes and can have lifelong consequences for infants. Smoking during pregnancy is associated with higher healthcare costs related to birth complications and during childhood. Psychosocial interventions to support pregnant women to quit are effective, yet provision of smoking cessation support has been inconsistent. The Midwives and Obstetricians Helping Mothers to Quit Smoking (MOHMQuit) intervention provides systems change, and leadership and clinician elements, to support clinicians to help women stop smoking in pregnancy. There have been few long-term analyses conducted of the cost-effectiveness of smoking cessation interventions for pregnant women that target healthcare providers. This protocol describes the economic evaluation of the MOHMQuit trial, a pragmatic stepped-wedge cluster-randomised controlled implementation trial in nine public maternity services in New South Wales (NSW), Australia, to ascertain whether MOHMQuit is cost-effective in supporting clinicians to help women quit smoking in pregnancy compared to usual care.MethodsTwo primary analyses will be carried out comparing MOHMQuit with usual care from an Australian health care system perspective: i) a within-trial cost-effectiveness analysis with results presented as the incremental cost per additional quitter; and ii) a lifetime cost-utility analysis using a published probabilistic decision analytic Markov model with results presented as incremental cost per quality-adjusted life-year (QALY) gained for mother and child. Patient-level data on resource use and outcomes will be used in the within-trial analysis and extrapolated and supplemented with national population statistics and published data from the literature for the lifetime analysis.DiscussionThere is increasing demand for information on the cost-effectiveness of implementing healthcare interventions to provide policy makers with critical information for the best value for money within finite budgets. Economic evaluation of the MOHMQuit trial will provide essential, policy-relevant information for decision makers on the value of evidence-based implementation of support for healthcare providers delivering services for pregnant women.Trial registrationsACTRN12622000167763, registered 2 February 2022.

Factors associated with the implementation of the 5As model of smoking cessation support during pregnancy: A scoping review.

The prevalence of smoking among pregnant women is the highest in the European region, making smoking cessation a public health priority. In order to address this, pregnant smokers need to be better supported by their healthcare professionals in their attempts to quit smoking. The 5As model, which is a psychosocial intervention, seems to be effective in this specific population. The objective of this review is to identify the factors that act as barriers or facilitators to the implementation of the 5As model within prenatal practices. We conducted a scoping review of the literature on PubMed and Scopus databases, using the terms: 'smoking cessation', 'pregnan*', and ('5A' or '5As'). The identified factors were categorized using a theoretical framework of The European Observatory on Health Systems and Policies. Among the 43 articles identified in the databases, 13 articles were included in this review. In total, we identified 48 factors. When necessary, we grouped them together, resulting in 12 sub-categories, which in turn were grouped into 9 categories. Those 9 categories were then classified into the 3 levels of the theoretical framework: the clinical level (motivation), the organizational level (healthcare pathway), and the health system level (political environment). The factors identified are varied and numerous and are involved in each level of the theoretical framework.