Trial Of Smoking Cessation Intervention Research Articles

Multiple Approaches and Participation Rate for a Community Based Smoking Cessation Intervention Trial in Rural Kerala, India

To illustrate multiple approaches and to assess participation rates adopted for a community based smoking cessation intervention programme in rural Kerala. Resident males in the age group 18-60 years who were 'current daily smokers' from 4 randomly allocated community development blocks of rural Thiruvananthapuram district, Kerala (2 intervention and 2 control groups) were selected. Smoking status was assessed through house-to-house survey using trained volunteers. Multiple approaches included awareness on tobacco hazards during baseline survey and distribution of multicolour anti-tobacco leaflets for intervention and control groups. Further, the intervention group received a tobacco cessation booklet and four sessions of counselling which included a one-time group counselling cum medical camp, followed by proactive counselling through face-to-face (FTF) interview and mobile phone. In the second and fourth session, motivational counselling was conducted. Among 928 smokers identified, smokers in intervention and control groups numbered 474 (mean age: 44.6 years, SD: 9.66 years) and 454 respectively (44.5 years, SD: 10.30 years). Among the 474 subjects, 75 (16%) had attended the group counselling cum medical camp after completion of baseline survey in the intervention group, Among the remaining subjects (n=399), 88% were contacted through FTF and mobile phone (8.5%). In the second session (4-6 weeks time period), the response rate for individual counselling was 94% (78% through FTF and 16% through mobile phone). At 3 months, 70.4% were contacted by their mobile phone and further, 19.6% through FTF (total 90%) while at 6 months (fourth session), the response rate was 74% and 16.4% for FTF and mobile phone respectively, covering 90.4% of the total subjects. Overall, in the intervention group, 97.4% of subjects were being contacted at least once and individual counselling given. Proactive community centred intervention programmes using multiple approaches were found to be successful to increase the participation rate for intervention.

A Randomized Clinical Trial of Smoking Cessation Treatments Provided in HIV Clinical Care Settings

Identifying successful smoking treatment interventions and methods of delivery is critical given the smoking rates among HIV-positive populations and the medical implications of smoking in this population. This study compared the efficacy of 3 smoking cessation interventions provided in HIV clinical treatment settings. Following a baseline assessment, 209 HIV-positive smokers were randomly assigned to 1 of 3 conditions in a parallel group design. Treatment conditions were individual counseling plus nicotine replacement treatment (NRT), a computer-based Internet smoking treatment plus NRT, and self-help plus NRT. Smoking status was determined at follow-up assessments completed at 12, 24, 36, and 52 weeks following treatment initiation. Cessation rates ranged from 15% to 29%; however, no statistically significant differences in abstinence were found among the treatment conditions over time. Those employed, those who reported a greater desire to quit, or those with lower mood disturbance scores were more likely to achieve abstinence (p < .01). The number of cigarettes participants reported smoking in the 24hr prior to each assessment significantly declined over time (p < .001). Although we found no differences in abstinence rates across groups, the results indicate that integration of smoking cessation interventions is feasible in HIV clinical treatment settings, and cessation results are promising. The overall abstinence rates we report are comparable to those found in similar treatment studies across multiple populations. Further research is warranted.

A randomized trial of a brief smoking cessation intervention in a light and intermittent Hispanic sample.

This study assessed the efficacy of a brief smoking cessation intervention in a light and intermittent smoking Hispanic sample. Two hundred fifty light (≤10 cigarettes per day) and intermittent smokers (nondaily smokers) (LITS) were recruited from a family health clinic and a border-region university; data from Hispanic participants (n = 214; 52.8% female) were analyzed for the purposes of the present study. Participants completed baseline measures assessing demographics, tobacco use/history, stage of change (SOC), perceived competence to quit smoking, and expired carbon monoxide (CO). Participants were randomly assigned to an immediate (II) or delayed (DI) brief cessation intervention. Psychology graduate students provided the intervention, which primarily addressed motivation, self-efficacy, and trigger management; blinding to condition was not feasible at follow-up. At the 3-month follow-up, smoking status, SOC, and perceived competence score (PCS) were assessed and analyzed via logistic and linear regression models by intervention assignment. Results indicated that intervention assignment was not associated with past 30-day smoking cessation (5.6% immediate condition vs. 4.7% delayed condition) or PCS. Nevertheless, participants in the II were more likely to increase readiness to quit smoking relative to those in the DI. Future efforts should focus on capitalizing on motivation change to promote smoking cessation.

Selection of intervention components in an internet stop smoking participant preference trial: Beyond randomized controlled trials

To address health problems that have a major impact on global health requires research designs that go beyond randomized controlled trials. One such design, the participant preference trial, provides additional information in an ecologically valid manner, once intervention efficacy has been demonstrated. The current study presents illustrative data from a participant preference trial of an internet-based smoking cessation intervention. Participants (N=7763) from 124 countries accessed the intervention and were allowed to choose from nine different site components to aid their quit attempt. Of consenting participants, 36.7% completed at least one follow-up assessment. Individuals with depression were more likely to choose a mood management module and participants who smoked a higher number of cigarettes were more likely to choose a cigarette counter and a nicotine replacement therapy guide. Furthermore, depressed participants selecting the mood management component were more likely to report at least one successful 7 day quit (37.2% vs. 22.2%) in the 12 months following the intervention. Thus, participants with depressive symptoms appear to make choices on the basis of their needs and to benefit from these decisions. This suggests that providing the ability to customize previously validated resources may be a successful way to widely disseminate interventions.

Comparative effectiveness trial of family-supported smoking cessation intervention versus standard telephone counseling for chronically ill veterans using proactive recruitment

Comparative effectiveness trial of family-supported smoking cessation intervention versus standard telephone counseling for chronically ill veterans using proactive recruitment Lori A Bastian,1–3 Laura J Fish,4 Jennifer, M Gierisch,3,5 Lesley D Rohrer,3 Karen M Stechuchak,3 Steven C Grambow,3,61Veterans Affairs Connecticut, West Haven, CT, USA; 2Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA; 3Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 4Duke Comprehensive Cancer Center, 5Department of Medicine, 6Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USAObjectives: Smoking cessation among patients with chronic medical illnesses substantially decreases morbidity and mortality. Chronically ill veteran smokers may benefit from interventions that assist them in harnessing social support from family and friends.Methods: We proactively recruited veteran smokers who had cancer, cardiovascular disease, or other chronic illnesses (diabetes, chronic obstructive pulmonary disease, hypertension) and randomized them to either standard telephone counseling or family-supported telephone counseling focused on increasing support for smoking cessation from family and friends. Participants each received a letter from a Veterans Affairs physician encouraging them to quit smoking, a self-help cessation kit, five telephone counseling sessions, and nicotine replacement therapy, if not contraindicated. The main outcome was 7-day point prevalent abstinence at 5 months.Results: We enrolled 471 participants with mean age of 59.2 (standard deviation [SD] = 7.9) years. 53.0% were white, 8.5% were female, and 55.4% were married/living as married. Overall, 42.9% had cardiovascular disease, 34.2% had cancer, and 22.9% had other chronic illnesses. At baseline, participants were moderately dependent on cigarettes as measured by the Heaviness of Smoking Index (mean = 2.8, SD = 1.6), expressed significant depressive symptoms as measured by the Center for Epidemiological Studies Depression scale (54.8% > 10), and reported high self-efficacy for quitting (mean = 5.7; SD = 1.5). At 5-months follow-up, we found no differences in smoking cessation by arm: 19.8% in the family-supported intervention and 22.0% in the standard arm. The following factors were associated with smoking cessation at 5 months: having cardiovascular disease or other diagnosis compared to cancer, lower nicotine dependence, older age, and higher self-efficacy.Conclusions: This comparative effectiveness trial among chronically ill veterans did not find differences in smoking cessation by type of intervention. Future studies should expand upon our findings and consider tailoring proactive telephone-based interventions based on age and type of disease.Keywords: smoking cessation, veterans, social support, counseling, proactive, family

Enhancing partner support to improve smoking cessation

While many cessation programmes are available to assist smokers in quitting, research suggests that partner involvement may encourage long-term abstinence. The purpose of this review was to determine if an intervention to enhance partner support helps smoking cessation when added as an adjunct to a smoking cessation programme, and to estimate the size of any effect. For the most recent update, the search was limited to the Cochrane Tobacco Addiction Group Specialized Register. This was searched in December 2011. The Specialized Register includes reports of controlled trials of smoking cessation identified from electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL) to Issue 4, 2011, MEDLINE to update 20110826, EMBASE to 2011 week 33, PsycINFO to 20110822 and Web of Science. The search terms used were smoking (prevention, control, therapy), smoking cessation, and support (family, marriage, spouse, partner, sexual partner, buddy, friend, co-habitees and co-worker). Randomized controlled trials of smoking cessation interventions that compared an intervention that included a partner support component with an otherwise identical intervention and reported follow-up of six months or longer. Two authors independently identified the included studies and extracted data using a structured form. A third author was consulted to aid in the resolution of discrepancies. Abstinence, biochemically validated if possible, was the primary outcome measure and was extracted at two post-treatment intervals: six to nine months and 12 months or greater. Partner Interaction Questionnaire and Support Provided Measure scores were also analysed to assess partner support. A fixed-effect model was used to pool relative risks from each study and estimate a summary effect. A total of 57 articles were identified for this review. Twelve articles (13 studies, > 2000 participants) met the inclusion criteria. The definition of partner varied between studies. All studies gave self-reported smoking cessation rates, but there was limited biochemical validation of abstinence. The pooled risk ratio for self-reported abstinence was 0.99 (95% confidence interval (CI) 0.84 to 1.15) at six to nine months and 1.04 (95% CI 0.87 to 1.24) at 12 months or more post-treatment. Of the eight studies that measured partner support at follow-up, only two studies reported a significant increase in partner support in the intervention groups. One study reported a significant increase in partner support in the intervention group, but smokers' reports of partner support received did not differ significantly in this study. In this review of randomized controlled trials of interventions designed to enhance partner support for smokers in cessation programmes, we failed to detect an increase in quit rates. Limited data from several of the trials suggest that these interventions also did not increase partner support. No conclusions can be made about the impact of partner support on smoking cessation. Additional studies with larger samples are needed to adequately explore the effects of partner support interventions for smoking cessation.

Eating the elephant whole or in slices: views of participants in a smoking cessation intervention trial on multiple behaviour changes as sequential or concurrent tasks

BackgroundThis paper explores smoking cessation participants’ perceptions of attempting weight management alongside smoking cessation within the context of a health improvement intervention implemented in Glasgow, Scotland.MethodsOne hundred and thirty-eight participants were recruited from smoking cessation classes in areas of multiple deprivation in Glasgow and randomised to intervention, receiving dietary advice, or to control groups. The primary outcome of the study was to determine the % change in body weight. Semi-structured interviews were conducted with a purposive sample of 15 intervention and 15 control participants at weeks 6 (during the intervention) and 24 (at the end of the intervention). The current paper, though predominantly qualitative, links perceptions of behaviour modification to % weight change and cessation rates at week 24 thereby enabling a better understanding of the mediators influencing multiple behaviour change.ResultsOur findings suggest that participants who perceive separate behaviour changes as part of a broader approach to a healthier lifestyle, and hence attempt behaviour changes concurrently, may be at comparative advantage in positively achieving dual outcomes.ConclusionsThese findings highlight the need to assess participants’ preference for attempting multiple behaviour changes sequentially or simultaneously in addition to assessing their readiness to change. Further testing of this hypothesis is warranted.Trial RegistrationISRCTN94961361

The Social Support and Social Network Characteristics of Smokers in Methadone Maintenance Treatment

Background: Previous studies have shown social support and social network variables to be important factors in smoking cessation treatment. Tobacco use is highly prevalent among individuals in methadone maintenance treatment (MMT). However, smoking cessation treatment outcomes in this vulnerable subpopulation have been poor and social support and social network variables may contribute. Methods: The current study examined the social support and social network characteristics of 151 MMT smokers involved in a randomized clinical trial of smoking cessation treatments. Participants were 50% women and 78% Caucasian. A high proportion (57%) of MMT smokers had spouses or partners who smoke and over two-thirds of households (68.5%) included at least one smoker. Results: Our sample was characterized by relatively small social networks, but high levels of general social support and quitting support. The number of cigarettes per day was found to be positively associated with the number of smokers in the social network (r = .239, p < .05) and quitting self-efficacy was negatively associated with partner smoking (r = −.217, p < .001). Conclusions: Findings are discussed in the context of developing smoking cessation interventions that address the influential role of social support and social networks of smokers in MMT.

Spirometric Predictors of Lung Function Decline and Mortality in Early Chronic Obstructive Pulmonary Disease

The course of lung function decline for smokers with early airflow obstruction remains undefined. It is also unclear which early spirometric characteristics identify individuals at risk for rapid decline and increased mortality. To determine the association between spirometric measures and 5-year decline in FEV(1) and 12-year mortality. We analyzed longitudinal data from the Lung Health Study, a clinical trial of intensive smoking cessation intervention with or without bronchodilator therapy in 5,887 smokers with mild to moderate airflow obstruction. Participants were stratified into bins of baseline FEV(1) to FVC ratio, using bins of 5%, and separately into bins of Z-score (difference between actual and predicted FEV(1)/FVC, normalized to SD of predicted FEV(1)/FVC). Associations between spirometric measures and FEV(1) decline and mortality were determined after adjusting for baseline characteristics and time-varying smoking status. The cohort was approximately two-thirds male, predominantly of white race (96%), and with mean age of 49 ± 7 years. In general, individuals with lower lung function by any metric had more rapid adjusted FEV(1) decline. A threshold for differential decline was present at FEV(1)/FVC less than 0.65 (P < 0.001) and Z-score less than -2 (2.3 percentile) (P < 0.001). At year 12, 575 (7.2%) of the cohort had died. Lower thresholds of each spirometric metric were associated with increasing adjusted hazard of death. Smokers at risk or with mild to moderate chronic obstructive pulmonary disease have accelerated lung function decline. Individuals with lower baseline FEV(1)/FVC have more rapid decline and worse mortality.

The protocol for the Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote Aboriginal Australian health care setting.

BackgroundAustralian Aboriginal peoples and Torres Strait Islanders (Indigenous Australians) smoke at much higher rates than non-Indigenous people and smoking is an important contributor to increased disease, hospital admissions and deaths in Indigenous Australian populations. Smoking cessation programs in Australia have not had the same impact on Indigenous smokers as on non-Indigenous smokers. This paper describes the protocol for a study that aims to test the efficacy of a locally-tailored, intensive, multidimensional smoking cessation program.Methods/DesignThis study is a parallel, randomised, controlled trial. Participants are Aboriginal and Torres Strait Islander smokers aged 16 years and over, who are randomly allocated to a 'control' or 'intervention' group in a 2:1 ratio. Those assigned to the 'intervention' group receive smoking cessation counselling at face-to-face visits, weekly for the first four weeks, monthly to six months and two monthly to 12 months. They are also encouraged to attend a monthly smoking cessation support group. The 'control' group receive 'usual care' (i.e. they do not receive the smoking cessation program). Aboriginal researchers deliver the intervention, the goal of which is to help Aboriginal peoples and Torres Strait Islanders quit smoking. Data collection occurs at baseline (when they enrol) and at six and 12 months after enrolling. The primary outcome is self-reported smoking cessation with urinary cotinine confirmation at 12 months.DiscussionStopping smoking has been described as the single most important individual change Aboriginal and Torres Strait Islander smokers could make to improve their health. Smoking cessation programs are a major priority in Aboriginal and Torres Strait Islander health and evidence for effective approaches is essential for policy development and resourcing. A range of strategies have been used to encourage Aboriginal peoples and Torres Strait Islanders to quit smoking however there have been few good quality studies that show what approaches work best. More evidence of strategies that could work more widely in Indigenous primary health care settings is needed if effective policy is to be developed and implemented. Our project will make an important contribution in this area.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ACTRN12608000604303)

A cluster randomised controlled trial of an adolescent smoking cessation intervention: Short and long-term effects

There is a lack of effective smoking cessation interventions which have a high reach among adolescent smokers. We conducted a randomised controlled trial of an adolescent smoking cessation intervention for students aged 15-21 at 22 continuation schools in Denmark. The intervention was a minimal intervention based on events with short counselling and a range of self-help materials. Our 1-month follow up consisted of 514 baseline daily smokers and the 14-month follow up of 369 daily smokers. We found positive short-term effects regarding smoking cessation (adjusted OR 4.50, 95% CI 1.20-16.86), self-efficacy (p=0.01), and intentions to quit (p=0.004). However, none of these effects were maintained at 1-year follow up. The intervention was successful in reaching more than half of all daily smokers in the target group with more than 30% receiving counselling at least once in the intervention period. This trial shows that a "minimal" intervention can produce short-term effects but that this approach is insufficient in producing long-term effects.

A Systematic Review of Smoking Cessation Intervention Studies in China

China has the highest number of tobacco smokers among the world's nations; however, no systematic review has been conducted of clinical trials on the efficacy of smoking cessation interventions in China. This paper summarizes findings of studies in order to compare the effect of pharmacotherapy, counseling, and Traditional Chinese Medicine (TCM) approaches on the abstinence rate. Clinical trials of smoking cessation interventions published in English or Chinese were extracted from an electronic search of PubMed and WanFang databases. The search yielded 234 studies from the PubMed and 78 studies from the WanFang. Twenty-nine studies were included in this review. Of these, 11 (37.9%) were randomized controlled trials (RCTs) that assessed the following approaches: counseling (5 studies), TCM (3 studies), pharmacotherapy (1 study), a combination of pharmacotherapy and counseling (1 study), and physician advice (1 study). Pharmacotherapy alone or in combination with counseling generally resulted in a higher abstinence rate than counseling alone. TCM techniques such as acupuncture and ear point seed pressure yielded a much higher abstinence rate than pharmacotherapy and counseling. Findings are inconclusive, however, because most of the TCM studies were noncontrolled trials and did not provide a definition of "abstinence." Findings on the effectiveness of physician advice to quit smoking were also inconclusive. A review of smoking cessation studies revealed that pharmacotherapy was effective in China. More RCTs of TCM approaches and physician advice are needed with long-term follow-up assessments and biochemical verification of self-reported abstinence before these approaches are adopted as evidence-based smoking cessation interventions in China.

Predictors of Relapse in a Bupropion Trial for Smoking Cessation in Recently-Abstinent Alcoholics: Preliminary Results Using an Aggregate Genetic Risk Score

IntroductionRates of smoking in the US population have decreased overall, but rates in some groups, including alcoholic smokers, remain high. Many newly sober alcoholics are concerned about their smoking and some attempt to quit. However, quit rates in this population are low. Prior studies suggest risk for relapse in this population may be genetically influenced and that genetic factors may moderate response to treatment.MethodsIn this exploratory study, we had two specific aims: (1) to investigate associations between genetic risk and outcome; (2) to investigate whether genetic risk moderates the efficacy of a medication intervention. Data are from a subsample of 90 participants from a clinical trial of smoking cessation treatment for smokers with between 2 and 12 months of alcohol abstinence. Subjects were randomly assigned to bupropion or placebo. All subjects received counseling and nicotine patches. To examine the possibility that bupropion may have been efficacious in participants with a specific genetic profile (ie, a pharmacogenetic approach), an aggregate genetic risk score was created by combining risk genotypes previously identified in bupropion treatment studies.ResultsAlthough medication efficacy was not moderated by the aggregate genetic risk score, there was an interaction between nicotine dependence and genetic risk in predicting smoking abstinence rates at the end of treatment (10 weeks).ConclusionsResults suggest an aggregate genetic risk score approach may have utility in treatment trials of alcoholics who smoke. Additionally, these findings suggest a strategy for understanding and interpreting conflicting results for single genetic markers examined as moderators of smoking cessation treatment.

Correlates of expected positive and negative support for smoking cessation among a sample of chronically ill veterans

Objective To examine demographic, relationship, and smoking history factors related to expected positive and negative support for quitting smoking among chronically ill veterans. Methods Data for this report comes from baseline data from a randomized controlled trial of a support-based smoking cessation intervention for veterans with chronic diseases (cancer, cardiovascular disease, hypertension, diabetes, and chronic obstructive pulmonary disease). We used separate multiple linear regression models to analyze relationships between positive and negative support and variables selected for model entry. Results Veterans in our sample expected high positive and negative support for quitting. Veterans who were married/living as married, had some college education, were female, or named a female support person expected higher levels of positive support. Veterans who named a female or a nonsmoker as a support person expected higher levels of negative support. Males and non-Caucasians also reported higher levels of expected negative support. Conclusions Individual differences that influence perceptions of expected support are likely to influence intervention participation and engagement. Thus, understanding factors associated with expected positive and negative support is necessary to optimize future implementation of support-based cessation interventions through better treatment matching.

Reading and critiquing randomized controlled trials

African Journal of Midwifery and Women's HealthVol. 5, No. 3 Research & EducationReading and critiquing randomized controlled trialsMargaret Goodman, Mollie GilchristMargaret GoodmanSearch for more papers by this author, Mollie GilchristSearch for more papers by this authorMargaret Goodman; Mollie GilchristPublished Online:23 Sep 2013https://doi.org/10.12968/ajmw.2011.5.3.129AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Centre for Reviews and Dissemination (2009) Systematic reviews: CRD's guidance for undertaking reviews in health care. University of York, York Google ScholarCritical Appraisal Skills Programme, NHS Public Health Resource Unit (2006) 10 questions to help you make sense of randomised controlled trials. http://www.phru.nhs.uk/Pages/PHD/resources.htm (accessed 15 September 2009) Google ScholarCentre for Evidence Based Medicine (CEBM) at the University of Oxford (2009) EBM tools: Critical Appraisal; explanations & examples. Numbers Needed to Treat. http://tinyurl.com/lm9p99 (accessed 22 September 2009) Google ScholarDelaney L (2009) Inferential analysis: powerful storytelling. British Journal of Cardiac Nursing 4(9): 430–4 Link, Google ScholarGoodman H, Parsons A, Davison J, Preedy M, Peters E, Shuldham C, Pepper J and Cowie M (2008) A randomised controlled trial to evaluate a nurse-led programme of support and lifestyle management for patients awaiting cardiac surgery, ‘Fit for surgery: fit for life’ study. Eur J Cardiovasc Nurs 7: 189–95 Crossref, Google ScholarHolt J (2009) Quantitative research: an overview. British Journal of Cardiac Nursing 4(5): 234–6 Link, Google ScholarJolly K, Lip GYH, Taylor RS, Raftery J, Mant J, Lane D, Greenfield S, Stevens A (2009) The Birmingham rehabilitation uptake maximisation study (BRUM): a randomised control trial comparing home-based with centre-based cardiac rehabilitation. Heart 95: 36–42 Crossref, Google ScholarLanman JT, Guy LP, Dancis J, (1954) Retrolental fibroplasias and oxygen therapy. JAMA 155: 223–5 Crossref, Google ScholarMoule P, Goodman M (2009) Nursing Research: An Introduction. Sage, London Google ScholarPolit DF, Beck CT (2008) Nursing Research: generating and assessing evidence for nursing practice. 8th edn. Lippencott Williams and Wilkins, Philadelphia Google ScholarQuist-Paulsen P, Gallefosse F (2003) Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease. BMJ 327: 1254 Crossref, Google ScholarRitin SF, Davidson P, Griffiths R, Juergens C, Stafford B, Salamonson Y (2009) A pilot randomised controlled trial comparing a health-related lifestyle self-management intervention with standard cardiac rehabilitation following an acute cardiac event: implications for a larger clinical trial. Australian Critical Care 22: 17-27 Crossref, Google ScholarSibbald B, Roland M (1998) Understanding controlled trials: why are randomised controlled trials important? BMJ 316: 201 Crossref, Google ScholarSim J, Wright C (2000) Research in Health Care – concepts, designs and methods. Stanley Thornes, Cheltenham Google Scholar FiguresReferencesRelatedDetails 1 July 2011Volume 5Issue 3ISSN (online): 2052-4293 Metrics History Published online 23 September 2013 Published in print 1 July 2011 Information© MA Healthcare LimitedPDF download

Projected Cost-effectiveness of Smoking Cessation Interventions in Patients Hospitalized With Myocardial Infarction

As many as 70% of smokers with acute myocardial infarction (AMI) continue to smoke after hospital discharge despite high rates of inpatient smoking cessation counseling. Supportive contact after discharge improves quit rates but is rarely used. Using data from a meta-analysis of randomized trials of smoking cessation interventions and other published sources, we developed a Monte Carlo model to project health and economic outcomes for a hypothetical US cohort of 327,600 smokers hospitalized with AMI. We compared routine care, consisting of advice to quit smoking, with counseling with supportive follow-up, consisting of routine care and follow-up telephone calls from a nurse after discharge. Primary outcomes were number of smokers, AMIs, and deaths averted; health care and productivity costs; cost per quitter; and cost per quality-adjusted life-year. Implementation of smoking cessation counseling with follow-up contact for the 2010 cohort of hospitalized smokers would create 50,230 new quitters, cost $27.3 million in nurse wages and materials, and prevent 1380 nonfatal AMIs and 7860 deaths. During a 10-year period, it would save $22.1 million in reduced hospitalizations but increase health care costs by $166.4 million, primarily through increased longevity. Productivity costs from premature death would fall by $1.99 billion and nonmedical expenditures would increase by $928 million, for a net positive value to society of $894 million. The program would cost $540 per quitter considering only intervention costs. Cost-effectiveness would be $5050 per quality-adjusted life-year. Results were sensitive to the utility and incidence of nonfatal AMI and the potential effect of pharmacotherapies. Smoking cessation counseling with supportive contact after discharge is potentially cost-effective and may reduce the incidence of smoking and its associated adverse health events and social costs.

Racial differences in eligibility and enrollment in a smoking cessation clinical trial.

The purpose of this study was to compare the recruitment, eligibility screening, and enrollment of African American and White smokers into an intensive smoking cessation intervention trial [The Chicago STOP Smoking Trial (C-STOP)]. We compared demographic, smoking, substance use, and medical/psychiatric screening data from the recruitment records of 1,189 non-Hispanic, African American and White smokers screened for eligibility in the last year of a randomized pharmacological and behavioral smoking cessation trial. The study took place at a large urban medical center and two satellite locations within the Chicago metropolitan area. Interest levels in the study were high among African American smokers, with twice as many African Americans as Whites contacting study staff for information and an initial screening. However, African Americans were nearly three times as likely not to be enrolled in the trial as Whites, because of higher ineligibility rates, failure to attend a screening session, and lower participation rates even among those meeting eligibility requirements. Racial differences were observed nearly at all levels of enrollment determination. These critical barriers to inclusion of African Americans in smoking cessation research limit our understanding of treatment efficacy and ultimately the ability to reduce the health disparities in tobacco-related disease experienced by African Americans.

An Ecological Momentary Assessment analysis of relations among coping, affect and smoking during a quit attempt

This study used Ecological Momentary Assessment (EMA) data from smokers trying to quit to assess relations among coping, positive affect, negative affect and smoking. The effects of stress coping on affect and smoking were examined. Data from a randomized clinical trial of smoking cessation treatments were submitted to multi-level modeling to test the effects of coping with stressful events on subsequent affect and smoking. Center for Tobacco Research and Intervention, Madison, Wisconsin. A total of 372 adult daily smokers who reported at least one stressful event and coping episode and provided post-quit data. Participants' smoking, coping and affect were assessed in near real time with multiple EMA reports using electronic diaries pre- and post-quit. Multi-level models indicated that a single coping episode did not predict a change in smoking risk over the next 4 or 48 hours, but coping in men was associated with concurrent reports of increased smoking. Coping predicted improved positive and negative affect reported within 4 hours of coping, but these affective gains did not predict reduced likelihood of later smoking. Pre-quit coping frequency and gender moderated post-quit stress coping relations with later positive affect. Men and those with greater pre-quit coping frequency reported greater gains in positive affect following post-quit coping. Coping responses early in a quit attempt may help smokers trying to quit feel better, but may not help them stay smoke-free.

Effects of practitioner-delivered brief counseling and computer-generated tailored letters on cigarettes per day among smokers who do not quit—A quasi-randomized controlled trial

Background It is still unclear how brief counseling for smoking cessation, combined with proactive recruitment of participants, impacts on those smokers not reaching the primary treatment goal of tobacco abstinence. Thus, within a quasi-randomized controlled trial, we examined the effects of (1) practitioner-delivered brief advice and (2) computer-generated tailored letters on cigarettes per day (CPD) among participants not succeeding in quitting. Methods A total of 34 general practices (participation rate 87%) were randomly selected in a German region. Within these practices, 1499 daily smoking patients aged 18–70 years (participation rate 80%) agreed to participate in a smoking cessation intervention trial. Allocation to study condition was based on time of practice attendance. Latent growth analyses were performed on the subsample of 1334 (89%) smokers who did not reach 6-month prolonged abstinence within the 2-year follow-up period. CPD was assessed at baseline and at 6-, 12-, 18-, and 24-month follow-ups. Results Both interventions led to small but significant reductions in CPD, and they did not differ in efficacy. Treatment effects occurred within the first 6 months and could be sustained by the continuing smokers until the 24-month follow-up. Conclusions Present results complement earlier findings of increased abstinence rates in the total sample. It can be concluded that, even if applied to unselected samples of smokers, from which only a minority initially intends to change, both brief counseling strategies are able to significantly decrease tobacco consumption. They hence appear to provide a means to reducing tobacco-related disease among general medical practice patients.

Hippocampal and striatal gray matter volume are associated with a smoking cessation treatment outcome: results of an exploratory voxel-based morphometric analysis

Compared to nonsmokers, smokers exhibit a number of potentially important differences in regional brain structure including reduced gray matter (GM) volume and/or density in areas including frontal and cingulate cortices, thalamus, and insula. However, associations between brain structure and smoking cessation treatment outcomes have not been reported. In the present analysis we sought to identify associations between regional GM volume--as measured by voxel-based morphometry (VBM)--and a smoking cessation treatment outcome (point prevalence abstinence at 4 weeks). Adult smokers underwent high-resolution anatomical MRI scanning prior to an open label smoking cessation treatment trial. VBM was conducted in SPM5 using the DARTEL algorithm and relapser vs. quitter groups were compared using independent sample t tests (p < 0.001, uncorrected). Analyses controlled for potentially confounding factors including years smoked, cigarettes per day, total intracranial volume (TIV), and sex. Of 18 smokers, 8 achieved a 4-week point prevalence abstinence, confirmed by CO level (<or=8 ppm). After controlling for all covariates, compared to relapsers, quitters had significantly higher GM volume in the left putamen and right occipital lobe, while also significantly lower GM volume in bilateral hippocampus and right cuneus. These preliminary results suggest that maintaining smoking abstinence is associated with higher pre-quit brain volume in regions that subserve habit learning and visual processing, and lower brain volume in regions that subserve long-term memory processes and visual information processing. Future, large-scale studies can determine whether brain structure variables can serve as clinically useful predictors of smoking cessation treatment outcome.