Tobacco Cessation Counseling Research Articles

A Heart Healthy Intervention Improved Tobacco Screening Rates and Cessation Support in Primary Care Practices.

We examined whether an evidence-based cardiovascular disease risk reduction intervention (Heart Health Now) would improve rates for tobacco cessation screening and counseling in small primary care practices in North Carolina. Heart Health Now was a stepped wedge, stratified, cluster randomized trial for primary care practices that were staffed by 10 or fewer clinicians and had an electronic health record. The Heart Health Now intervention consisted of education tools, onsite practice facilitation for one year, and a practice-specific cardiovascular population management dashboard that included monthly, measure-specific run charts to help guide quality improvement. Our primary outcomes were practice-level rates of tobacco screening and tobacco cessation support-extracted from practices' electronic health records-and measured at pre-intervention and 6 months post-intervention. The 28 practices included in our analyses represented 78,120 patients and 17,687 smokers. Significant change occurred in practices' tobacco screening rates and cessation support rates over time. From pre- to post-intervention, screening rates significantly increased from 82.7 to 96.2% (p < 0.001). Similarly, cessation support rates significantly increased from 44.3 to 50.1% (p = 0.03). Several practice-level factors were associated with improvement including being in an academic health center or faculty practice, having more clinicians, and having a lower percentage of White patients. In conclusion, a multi-component intervention focused on multiple cardiovascular disease risk reduction in multiple small primary care practices successfully improved rates of tobacco screening and cessation support.

Smoking Status of Faculty and Their Tobacco Cessation Counselling Advisory

IntroductionHealth professionals’ own beliefs and practices, especially their smoking status, has been described to strongly influence their willingness to provide brief tobacco interventions (5 A's) to their patients. This study examines the association between the smoking status of faculty members in US dental programmes and (1) practice pattern; (2) perceived confidence; and (3) perceived educational preparedness of new graduates in providing the 5 A's to their patients. MethodsThis study presents data from the National Tobacco Survey of Personnel in Dental and Allied Academic Programs (TSPDAP) conducted in 2018. Faculty members in US dental/allied dental schools were invited to participate in this survey. Data were stratified based on the smoking status of the respondents as “never” and “ever” smokers (smoked <100 and ≥100 cigarettes during their lifetime, respectively). Multiple logistic regression models were used to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs). ResultsData of 1896 participants were analysed, of whom 1032 (54.4%) were categorised as “ever” smokers. In the final regression model, low perceived barrier score was significantly associated with high practice pattern (aOR, 0.94; 95% CI, 0.92-0.97), high perceived confidence (aOR, 0.92; 95% CI, 0.90-0.95), and high perceived educational preparedness (aOR, 0.97; 95% CI, 0.94-0.98) in delivering the 5 A's to patients. Similarly, high perceived effectiveness was significantly associated with high practice pattern (aOR, 1.08; 95% CI, 1.05-1.11), high perceived confidence (aOR, 1.10; 95% CI, 1.06-1.13), and high perceived educational preparedness (aOR, 1.06; 95% CI, 1.03-1.09) in delivering the 5 A's to their patients. The smoking status of the dental personnel did not show any significant association with practice pattern, perceived confidence, or perceived educational preparedness in delivering the 5 A's to their patients. ConclusionsThe smoking status of oral health care personnel was not significantly associated with their participation in tobacco cessation interventions.

Economic evaluations of tobacco control interventions in low- and middle-income countries: a systematic review.

Tobacco consumption and its associated adverse outcomes remain major public health issues, particularly in low- and middle-income countries. This systematic review aimed to identify and critically assess full economic evaluations for tobacco control interventions in low- and middle-income countries. Electronic databases, including EMBASE, MEDLINE and PsycINFO and the grey literature, were searched using terms such as 'tobacco', 'economic evaluation' and 'smoking' from 1994 to 2020. Study quality was assessed using the Consensus Health Economic Criteria and the Philips checklist. Studies were included which were full economic evaluations of tobacco control interventions in low- and middle-income settings. Reviews, commentaries, conference proceedings and abstracts were excluded. Study selection and quality assessment were conducted by two reviewers independently. A narrative synthesis was conducted to synthesize the findings of the studies. This review identified 20 studies for inclusion. The studies evaluated a wide range of interventions, including tax increase, nicotine replacement therapy (nicotine patch/gum) and financial incentives. Overall, 12 interventions were reported to be cost-effective, especially tax increases for tobacco consumption and cessation counselling. There were considerable limitations regarding data sources (e.g. using cost data from other countries or assumptions due to the lack of local data) and the model structure; sensitivity analyses were inadequately described in many studies; and there were issues around the transferability of results to other settings. Additionally, the affordability of the interventions was only discussed in two studies. There are few high-quality studies of the cost-effectiveness of tobacco use control interventions in low- and middle-income countries. The methodological limitations of the existing literatures could affect the generalizability of the findings.

A novel opt-in vs opt-out approach to referral-based treatment of tobacco use in Veterans Affairs (VA) primary care clinics: A provider-level randomized controlled trial protocol

To determine whether an opt-out approach is effective for referral to treatment for tobacco use, we designed a clinical reminder for nurses in a primary care setting that provides a referral for patients who smoke cigarettes. We will use a two-arm, cluster-randomized design to assign nurses at the VA New York Harbor Healthcare System to test which mode of referral (opt-in vs opt-out) is more effective. All patients will be referred to evidence-based treatment for tobacco cessation including counseling from the New York State Quitline, and VetsQuit, a text messaging-based system for tobacco cessation counseling. We will measure patient engagement with the referral both in the short and long term to determine if referral modality had an impact on tobacco cessation treatment. We will also measure nurse engagement with the referral before, during, and after the implementation of the reminder to determine whether an opt-out approach is cost effective at the health system level. At the conclusion of this project, we expect to have developed and tested an opt-out system for increasing tobacco cessation treatment for Veterans in VA primary care and to have a thorough understanding of factors associated with implementation.Trial Registration:Clinicaltrials.govIdentifierNCT03477435

Implementation and Uptake of Rural Lung Cancer Screening.

Given the higher rates of tobacco use along with increased mortality specific to lung cancer in rural settings, low-dose CT (LDCT)-based lung cancer screening could be particularly beneficial to such populations. However, limited radiology facilities and increased geographical distance, combined with lower income and education along with reduced patient engagement, present heightened barriers to screening initiation and adherence. In collaboration with community leaders and stakeholders, we developed and implemented a community-based lung cancer screening program, including telephone-based navigation and tobacco cessation counseling support, serving 18 North Texas counties. Funding was available to support clinical services costs where needed. We collected data on LDCT referrals, orders, and completion. To raise awareness for lung cancer screening, we leveraged our established collaborative network of more than 700 community partners. In the first year of operation, 107 medical providers referred 570 patients for lung cancer screening, of whom 488 (86%) were eligible for LDCT. The most common reasons for ineligibility were age (43%) and insufficient tobacco history (20%). Of 381 ordered LDCTs, 334 (88%) were completed. Among screened patients, 61% were current smokers and 36% had insurance coverage for the procedure. The program cost per patient was $430. Implementation, uptake, and completion of LDCT-based lung cancer screening is feasible in rural settings. Community outreach, health promotion, and algorithm-based navigation may support such efforts. Given low lung cancer screening rates nationally and heightened lung cancer risk in rural populations, similar programs in other regions may be particularly impactful.

Knowledge, Attitude, Practices, and Preparedness of Dental Professionals in Prescribing Nicotine Replacement Therapy.

Objective To assess the knowledge, practice, attitude, and preparedness of dental professionals in prescribing nicotine replacement therapy (NRT). Methodology. A prevalidated voluntary web-based questionnaire was generated as a link through Google Drive and was sent to 117 dental professionals in North India using Whatsapp, Messenger, and Instagram social media platforms. A total of 94 responses were received and out of which 76 responses were analyzed (18 forms were excluded due to incomplete or duplicate responses). Frequency analysis was done using SPSS software version 21. Result The participation rate was found to be 80.3%. More than half of the study population were familiar with the term NRT (77.6%) and its uses (67.1%), but approximately less than half of the total study subjects knew the duration (32.9%), cost (27.6%), dosage (25%), and contraindications (36.8%) of the NRT. Approximately 56.6% of the study participants showed a positive attitude towards helping patients to quit smoking through tobacco cessation counseling. Nearly one-fourth of the study population, i.e., 27.6%, were confident in explaining the negative impacts of tobacco, while 22.4% knew about the tobacco cessation protocol. Among the participants, only 27.6% reported that they practice NRT and out of which approximately less than 20% of the study participants were prescribing correct dose of NRT. Conclusion Though study subjects had an ample knowledge regarding NRT use in tobacco cessation, it does not reflect their current attitude and preparedness. Thus, there is a need for continuing education to further train dental professionals for prescribing NRT.

Role of dental practitioner in smoking cessation interventional programs

Oral cancer, periodontitis, reduced response to periodontal therapy, implant failure, tooth loss, dental caries, delayed wound healing, chronic candidiasis, staining, halitosis and premalignant tissue alteration are all caused or linked to smoking and smokeless tobacco use. Importantly, smoking cessation therapies (both brief and extensive) have been proved to be a very cost-effective method of prolonging life and lowering disease. Health care providers, notably dentists and dental hygienists, are responsible for providing smoking cessation care to individuals with oral difficulties. The purpose of this research was to review the available information about the effectiveness of dental practitioners in smoking cessation interventional programs. According to the existing literature, dental practitioners can play an essential role in the control and spread of tobacco-related oral disorders by including smoking cessation interventional programs. The negative health impacts of tobacco use as well as the benefits of quitting tobacco use and tobacco cessation counselling, should all be part of the dentist office's arsenal. Dental professionals are in a unique position to assist tobacco users seeking dental care by assisting them in quitting smoking.

Family History and Risk of Bladder Cancer: An Analysis Accounting for First- and Second-degree Relatives.

This study found a positive association between family history and bladder cancer in first- and second-degree relatives, with an added effect attributed to smoking. Given the detriments of bladder cancer, at-risk individuals should receive family history screening and tobacco cessation and avoidance counseling.

Demographic and Clinical Predictors of Engaging in Tobacco Cessation Counseling at a Comprehensive Cancer Center.

To address challenges promoting tobacco cessation in oncology settings, it is important to understand characteristics associated with patient engagement in tobacco cessation treatment. This analysis examined predictors of participating in at least one tobacco cessation counseling session among patients referred to a comprehensive cancer center's Tobacco Intervention and Psychosocial Support (TIPS) service. Patients with cancer who reported current smoking or recently quitting and referred to TIPS between June 2017 and February 2020 were included in the analysis. Independent variables included sex, race and ethnicity, insurance type, cancer diagnosis (tobacco-related or not), age, nicotine dependence, and cigarettes smoked per day at baseline. The outcome variable was completion of at least one tobacco cessation counseling session among those assessed by the TIPS program. Unadjusted and adjusted analyses tested associations between the independent variables and tobacco cessation counseling engagement. Of 360 oncology patients referred to the TIPS program, 224 (62.2%) were assessed and 120 (33%) engaged in at least one counseling session. After controlling for sociodemographics and tobacco use, the results demonstrated that patients diagnosed with tobacco-related cancers were 45.3% less likely to engage in the tobacco cessation program compared with those with non-tobacco-related cancers (P = .041). Patients diagnosed with tobacco-related cancers were less likely to engage in TIPS. Additional therapeutic resources may be needed to engage these patients to address potential explanatory factors, such as stigma, guilt, and fatalism. More research is needed to explore the impact of a tobacco-related cancer diagnosis on treatment engagement.

Markov model- Quantifying outlook towards success of tobacco cessation counseling.

Smoking is still a major public health issue that causes morbidity and mortality all over the world. The percentage of deaths caused by tobacco smoking has escalated from 1.4% in 1990 to 13.3% by 2020. There are numerous evidence-based tobacco control strategies available, and newer ones are always being developed. However, on ceasing the habit, cigarettes users go through a period of withdrawal with an increased percentage of relapse before entering to a more stable condition of sobriety in the long run. In this review, Endnote software was used as resource material to collect literature, which was then carefully arranged in a synchronised way. The Markov model captures the dynamic character of the quitting/relapse process, allowing for more accurate figures of abstinence rate, treatment outcomes and evaluating the performance of newer cessation initiatives during tobacco cessation counselling, as well as suggesting pathways for survivability.

Tobacco Cessation Counseling and Medications Provided by Physicians to Tobacco Users During Primary Care Visits.

Introduction:The established guidelines for treating tobacco use and dependency is brief provider intervention to assist those willing to quit by providing access to medication and/or behavioral counseling. The purpose of the study is to determine the extent of cessation treatment offered by providers during primary care visits by patients who are current tobacco users, and to examine associations between patient factors and treatment received.Methods:Using data from the 2015 to 2018 National Ambulatory Medical Care Survey (NAMCS), we examined tobacco cessation counseling and medications from 4590 visits by patients with current tobacco use. Separate multivariate logistic regressions were used to assess whether the odds of receiving tobacco cessation treatment varied by age, gender, race/ethnicity, and payment source.Results:Of visits by current tobacco users, 18.4% included cessation counseling, 5.5% included cessation medication, and 22.1% included at least 1 type of treatment. Visits by patients with Medicare had 44% greater odds of including counseling (CI = 1%-205%) and treatment (OR = 1.44; 95% CI = 1.01-2.06). Visits classified as “other payment type” had 73% greater odds of including counseling (OR = 1.73; 95% CI = 1.05-2.84). Visits by women had 86% greater odds of including medication (CI = 17%-294%).Conclusions:Tobacco cessation treatment is underutilized by providers during primary care visits. Further research is necessary to understand and address barriers to providing routine cessation assistance.

Assessment of nicotine dependence among cigarette smokers seeking oral health care using fagerström test for nicotine dependence: A cross-sectional study

Introduction: In the quest of articulating customized tobacco cessation strategies, evaluation of the level of nicotine dependence among participants is quintessential. Objective: This study was conducted to assess the levels of nicotine dependence and its association with age and socioeconomic status among patients seeking oral health care at a teaching dental institution in coastal Andhra Pradesh. Materials and Methods: This cross-sectional study was done among 199 participants with the habit of cigarette smoking who participated in the study. Nicotine dependence scores were assessed using Fagerström Test for Nicotine Dependence (FTND). IBM SPSS version 20 software was used for data analysis. The Chi-square tests and Kruskal–Wallis analyses of variance were done to analyze the study data. P ≤0.05 was considered statistically significant. Results: The mean FTND score was 4.52 ± 2.1. Significant differences in the mean nicotine dependence score were found between different age groups (P < 0.001) and participants belonging to different socioeconomic strata (P < 0.001). While a positive correlation was observed between age and FTND score, an inverse relation was noted between FTND score and socioeconomic status with participants from lower socioeconomic status demonstrating higher FTND scores. The majority of the participants reported smoking <10 cigarettes per day. Conclusion: The study participants demonstrated moderate nicotine dependence. The assessment of nicotine dependence scores as a preliminary step in tobacco cessation counseling is essential to effectively articulate customized cessation strategies.

Effect of non-pharmacological interventions on adults with cardiovascular risk in a rural community.

Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, with three-fourth of deaths occurring in low- and middle-income countries (LMICs) like India. Currently, three out of the top five causes of morbidity and mortality in the country are NCDs. This study evaluated the impact of non-pharmacological interventions as a comprehensive approach toward adults with cardiovascular risk in Indian rural communities. It was a quasi-experimental study conducted in Rishikesh, a holy city of Uttarakhand known as the world's yoga capital at the foothills of Himalaya. Out of 87 villages, four villages were randomly selected. Eighty-eight participants were enrolled (22 from each village and household). It was a multi-stage random sampling. All the participants with cardiovascular risk and age >30 years were recruited. Pregnant, severely ill, and unwilling to consent were excluded. Non-pharmacological intervention as a comprehensive approach, including yoga, meditation, mental health counseling, dietary counseling, tobacco, and alcohol cessation counseling has been provided to cardiovascular risk participants. Data of 76 participants were analyzed as the per-protocol analysis method. The drop-out rate was 13.63%. Male and female participants were 52 (68.4%) and 24 (31.6%) in number. Mean age of the participants was 55.28 ± 13.64 years. Diastolic blood pressure or DBP (P = 0.017*), systolic blood pressure or SBP (P = 0.008**), waist circumference (WC) (P = 0.000**), waist-to-hip ratio (P = 0.000**) and waist-to-height ratio (P = 0.000**) significantly improved in the post intervention group. Non-pharmacological interventions as a comprehensive approach can significantly reduce modifiable risk factors for cardio-metabolic disease.

Tobacco habit abstinence through behavioral counseling among transgender persons of pune district: A quasi-experimental design

Background: Transgender population are a high-risk group in the community, as their oral health gets neglected due to the stigma associated with them. Since it is an impediment to obtain oral care services, a group of such persons were identified with an intention of examining them orally and providing basic oral treatment. Aim: To identify a cohort of transgender persons using tobacco product and provide group behavioral counseling for cessation of their habit. Materials and Methods: A total of five locations wherein transgender persons were residing were identified. Demographic details of the participants such as age, education status, and occupation were recorded. The tobacco product use details regarding frequency, duration of use, and form of tobacco were documented. The identified tobacco users were provided with behavioral tobacco cessation counseling. Follow-up was done every month for 6 months and at 18th month through self-reported abstinence and urine cotinine test at 6th month. The data was analyzed using descriptive statistics in the form of numbers and percentages and the 95% confidence intervals (CIs) (Mid-P) were provided using WinPepi PORTAL. Results: A total of 52 transgender persons aged 18–58 years were identified. Tobacco product use was identified in 73%, out of which 13% smoked tobacco, 84% chewed tobacco, while 2% smoked and chewed both. Postintervention at 6th month, 21% (CI: 0.10–0.36) abstained from the habit of tobacco product use, which was self-reported and 7% (CI: 0.02–0.20) was validated with urine cotinine. By the 18th month, 15% (CI: 0.06–0.29) had self-reported abstinence. Conclusion: The prevalence of tobacco consumption was high among transgender population. Tobacco cessation program helped in quitting the adverse habit in 15% of the population. Cessation programs supplemented with nicotine replacement therapy use in this marginalized section of the society would help achieve a better abstinence.

Low Rates of Lung Cancer Screening Referrals in Patients With Human Immunodeficiency Virus: A Correlational Study.

People living with HIV (PLWH) have an increased risk of lung cancer compared to the general population. In 2013, the United States Preventive Services Task Force (USPSTF) released their lung cancer screening (LCS) guidelines. However, the impact of these guidelines has not been well established in PLWH. The objective of this retrospective descriptive study is to evaluate the frequency of lung cancer screening referrals and factors associated with LCS referrals using the 2013 USPSTF screening guidelines in at-risk PLWH. We collected demographic and clinical information on PLWH from electronic medical records from July 2016 to July 2018. Descriptive statistics, chi-square tests, t-tests, Wilcoxon rank sum tests, and Fisher’s exact tests were used for analysis. Only 14% of patients who met 2013 USPSTF screening guidelines were referred for screening. Patients who received a referral were more likely to have received tobacco cessation counseling. Patients who received and completed a referral were more likely to have hepatitis C infection. Quality improvement strategies are needed to improve rates of LCS in PLWH.

Implementation strategies for integrating tobacco cessation treatment in cancer care: A qualitative study.

The objective of this study was to determine how to optimize implementation of tobacco cessation treatment interventions in cancer care by (1) investigating the feasibility and acceptability of a multi-level approach to tobacco cessation treatment intervention, (2) identifying barriers and facilitators to implementation, and (3) eliciting additional strategies to improve implementation of the intervention. We conducted qualitative interviews with oncologists (n = 15) from one large academic health center in the Southeastern United States. We asked about their knowledge, attitudes, and current practices regarding tobacco use screening and treatment. We also asked about two proposed strategies to support implementation of tobacco cessation treatment: (1) developing a registry of tobacco users in collaboration with the state-run tobacco cessation program, and (2) providing on-site tobacco cessation counseling from trained professionals. Oncologists saw addressing tobacco use as valuable; however, they felt restricted from consistently addressing tobacco use by multi-level barriers such as workload, electronic health record (EHR) design, patient anxiety, and low self-efficacy for treating tobacco dependence. Oncologists responded positively to on-site treatment and felt this strategy would increase treatment accessibility and enhance engagement. Reaction to developing a registry of tobacco users was mixed, with concerns regarding lack of oncologist involvement and patient privacy expressed. Other suggested strategies for supporting implementation of tobacco cessation treatment included reducing referral complexity, establishing financial or quality incentives for oncologists, and leveraging existing EHR tools to facilitate integration of cessation interventions into clinic workflows. We identified several challenges to implementing tobacco use treatment in cancer care; however, we considered strategies to overcome these barriers that were viewed as feasible and acceptable. Our work highlights the importance of engaging stakeholders in implementation efforts. Future work should explore the impact of the implementation strategies identified in this study.

Tobacco Cessation Practices and Perceived Barriers for its Implementation among Nepali Dentists

Introduction: Tobacco use and its resulting ill health effects can be controlled by adopting appropriate cessation measures at individual, community and national level. Health care service providers, and particularly dentists, can play a major role in providing tobacco cessation counselling to the patients who come in their contact. Objective: To assess the tobacco cessation practices and perceived barriers for its implementation among Nepali dentists. Methods: This descriptive cross-sectional study using online questionnaire for data collection was done among 246 Nepali dentists selected by convenient sampling from November, 2020 to January, 2021 after ethical clearance from institutional review committee of Nepal Medical College. Data entered into Google Forms were exported to Microsoft Excel and SPSS v.20 for descriptive analysis. Results: A total of 246 (111, 45.1% male and 135, 54.9% female) dentists responded to the survey. Mean age of the respondents was 30.75±4.61 years. Most respondents (159, 64.6%) were from Bagmati province. Out of the participants, 204 (82.9%) were “never smokers” themselves. Most of the participants (161, 65.5%) asked patients about smoking habits, 176 (71.6%) advised patients not to start smoking and 119 (48.4%) rarely advised quitting tobacco. Only 15 (6.1%) dentists assisted patients to quit smoking. Among the perceived barriers, most reported lack of trainings (143, 58.1%). Conclusion: Even though majority of the study participants asked their patients about smoking habits, only few assisted them to quit. Those having received trainings regarding tobacco cessation being fewer in number further suggests the need of regular continuing medical education and trainings.

Clinical decision support for tobacco screening and counseling parents of pediatric patients: A qualitative analysis of pediatric emergency department and urgent care professionals

BackgroundClinical Decision Support Systems (CDSS) embedded into electronic medical records is a best practices approach. However, information is needed on how to incorporate a CDSS to facilitate parental tobacco cessation counseling and reduce child tobacco smoke exposure (TSE) in Pediatric Emergency Department (PED) and Urgent Care (UC) settings. The objective was to explore the barriers and enablers of CDSS use to facilitate child TSE screening and parental tobacco cessation counseling by PED/UC nurses and physicians. MethodsWe conducted 29 semi-structured, focused interviews with nurses (n = 17) and physicians (n = 12) at a children's hospital PED/UC. The interview guide included a brief presentation about the design and components of a prior CDSS tobacco intervention. Participants were asked their opinions about CDSS components and recommendations for adapting and implementing the CDSS tobacco intervention in the PED/UC setting. A thematic framework analysis method was used to code and analyze qualitative data. ResultsParticipant mean (± SD) age was 42 (± 10.1) years; the majority were female (82.8%), non-Hispanic white (93.1%), and never tobacco users (86.2%); all were never electronic cigarette users. Four themes emerged: (1) explore optimal timing to complete CDSS screening and counseling during visits; (2) CDSS additional information and feedback needs; (3) perceived enablers to CDSS use, such as the systematic approach; and (4) perceived barriers to CDSS use, such as lack of time and staff. ConclusionsThe CDSS intervention for child TSE screening and parental tobacco cessation during PED/UC visits received endorsements and suggestions for optimal implementation from nurses and physicians.

Understanding engagement behaviors and rapport building in tobacco cessation telephone counseling: An analysis of audio-recorded counseling calls

IntroductionThough telephone counseling is a modality commonly used to promote health behavior change, including tobacco cessation, specific counselor and participant behaviors that indicate engagement and therapeutic alliance remain poorly characterized in the literature. We sought to explore smokers' and counselors' engagement and rapport-building behaviors in telephone counseling for smoking cessation and patterns of these behaviors by smokers' psychiatric symptoms. MethodsThe study team transcribed, audio-recorded tobacco cessation counseling calls for the presence of engagement and rapport-building behaviors among recently hospitalized participants enrolled in a smoking cessation randomized controlled trial (RCT). The study used baseline data from the RCT to explore frequencies of counselors' and smokers' behaviors among smokers who had reported more (vs. fewer) symptoms of depression (PHQ8 ≥ 10) or anxiety (GAD7 ≥ 10) at study entry. ResultsParticipants (n = 37) were mostly female (23/37), White (26/37), with a median age of 58. At study entry while hospitalized, moderate-to-severe symptoms of depression (18/37) and anxiety (22/37) were common. Participant-led engagement behaviors included referencing past quit attempts, asking questions, elaborating response to yes/no questions, expressing commitment to behavior change, and assigning importance to nonautomated calls. Counselor-led behaviors included building off prior interaction, empathy, normalizing challenges, reframing and summarizing, validating achievements, and expressing shared experience. Both participants and counselors engaged via general discussion and humor. Participant-led engagement behaviors appeared more often in call transcripts among patients with higher baseline depression and anxiety symptoms compared to those with lower symptom scores. ConclusionsThis study classified participant-led, counselor-led, and shared engagement behaviors during tobacco cessation counseling calls. Increased engagement via telephone counseling may be important for individuals with psychiatric symptoms identified at the start of treatment.

Smoking Cessation Interventions During Chemoradiotherapy for Locally Advanced Cervical Cancer: A Missed Opportunity?

Smoking cessation education and intervention have been well-studied in patients with cervical dysplasia or smoking-related malignancies in efforts to improve health outcomes. Though smoking is associated with worse outcomes after chemoradiotherapy (CRT) for local advanced cervical cancer (LACC), the utilization and impact of smoking cessation interventions on patients with LACC during CRT and follow-up is unknown. We hypothesize that tobacco cessation interventions are under-utilized during CRT for LACC.Patients with LACC treated with definitive CRT from 2009 -2019 were identified from an IRB-approved retrospective institutional database. Smoking cessation education encounters with the institutional tobacco treatment program (TTP) during CRT and follow-up were identified within the electronic medical record. TTP encounters included counseling with or without pharmacologic therapy/nicotine replacement. Overall survival (OS) calculated with the Kaplan-Meier method. Fisher's exact and Wilcoxon rank sum tests were performed to identify differences in patients who quit smoking versus those who continued to smoke.Of 220 patients with LACC treated with CRT, 61 (28%) were smoking at time of diagnosis. Median follow-up from date of LACC diagnosis was 25 months. Smoking cessation education was provided to 39 patients (63.9%); however only 9 patients (15%) received these services during CRT. At last follow-up, 18 patients (29.5%) had quit smoking; nearly half of these patients (8/18, 44%) attempted cessation during CRT, while some patients (5/18, 27%) quit over one year after cancer diagnosis. The overall rate of smoking cessation was 23.1% (9/39) for patients who underwent counseling and 40.9% (9/22) for those who did not. After LACC diagnosis, the median time to first cessation attempt was 61 days, while median time to the first TTP interaction was 196 days. No significant difference in 3-year OS was found between patients who quit smoking compared to those who continued smoking (73% vs 56%, P = 0.7). There was also no difference in FIGO stage (P = 0.34), nodal status (P = 0.78), age (P = 0.50), or pack years smoking (P = 0.25) between patients who quit smoking and those who continued smoking.Most patients continued smoking after CRT for LACC, though cessation rates are higher than the national average (< 10%). Patients can successfully quit smoking during CRT, though few patients receive formal tobacco cessation counseling during treatment. Smoking cessation interventions should be maximized during CRT; however, interventions should also continue as part of a longitudinal, person-centered survivorship plan. Future work will attempt to ensure the success of smoking cessation attempts in patients with LACC by early referral to the TTP to augment cancer treatment and improve overall patient health and outcomes.E.S. Hollis: None. E. Ruebush: None. E. Davies: None. S. Paraghamian: None. A.A. Weiner: None.