Smoking Attitudes and Prevalence of a Somali Population in London

This research examines the prevalence and attitudes of smoking among a Somali population in London. Eight focus groups and 77 assisted questionnaires were conducted. Findings show that there was little knowledge of local smoking cessation services and several themes arose including: the format and ineffective promotion of the United Kingdom National Health Service (NHS) Stop Smoking Services, health prom xotion and ambivalence towards preventative health behaviour. Smoking rates in this Somali population appear to be higher than in the UK general population, and higher still among men over 40 years old and those that regularly use qat. Smoking cessation services for the Somali population may be more popular if there were group clinics and culturally effective promotion of the services. The relationship between qat use and smoking should be considered when targeting services to the Somali population.

Nicotine Absorption From Seven Current Nicotine Replacement Products and a New Wide-Bore Nicotine Delivery Device

This preliminary laboratory study investigated nicotine absorption rates of seven current nicotine replacement therapy (NRT) products and a new wide-bore nicotine delivery device (the ‘Nicotine Cannon’). The nicotine products (Cannon, inhalator, nasal spray, microtab, 2 mg and 4 mg gum and 2 mg and 4 mg lozenge) were used for ten minutes by two non-nicotine tolerant subjects. Blood was taken at frequent intervals for the next 60 minutes and plasma nicotine concentrations assessed. Of current NRT products investigated the 4 mg lozenge performed best with the highest blood nicotine levels at each time point, the 2 mg gum delivered the lowest concentrations at each time point. The nicotine nasal spray delivered nicotine the fastest of all the products. The Cannon delivered the highest blood nicotine concentration (mean 8.95 ng/ml) of all products one minute after device use had stopped, and the highest concentration (11 ng/ml) five minutes after termination of use. The Cannon showed it could deliver nicotine relatively rapidly in a manner that was readily tolerated by users.

Social Support and Success at Stopping Smoking

This article characterises the social support received by a large sample of smokers attempting to stop and the relationship between this and the outcome of their attempt. A survey was conducted of 928 smokers attending a group-based program. Smoking among colleagues and a perception of having someone to turn to predicted outcome at the end of treatment, 4 weeks from the quit date (Odds ratio [OR] = 0.81, p = .008 and OR = 1.31, p = .003 respectively) Among those who abstained for the first week, smoking among colleagues and the frequency with which they had been offered cigarettes predicted outcome at the end of treatment (OR = 0.81, p = .04 and OR = 0.73, p = .01 respectively). There were no significant social support correlates of cessation for 26 weeks. Social support has a role to play in the short-term, but in the context of a group-based treatment program appears not to be related to long-term success.

Client Satisfaction With English Stop Smoking Services

This study reports client satisfaction in five UK National Health Service (NHS) Stop Smoking Services (SSS) and examines the impact of satisfaction on outcome four weeks postquit. Six services were selected on the basis of perceived ability to run the study from a pool of 11 who responded to a mailshot to volunteer. Advisors made one of two satisfaction surveys available to their clients two weeks after quitting smoking. The two surveys were a ‘brief’ three-item survey and a ‘full’ survey containing those items plus 19 others about specific aspects of the service. There were two key items: how satisfied respondents were with the support they received to stop smoking and would they recommend the service to another smoker. Surveys were completed anonymously but had unique identification numbers so they could be linked to individual demographic and outcome data. Overall 10% (554/5520) of treated smokers in the services completed a survey, 7% (390/5520) completed the ‘full’ survey. Responses were a strong endorsement of the participating services, with 93% (505/542) satisfied or very satisfied with the service and 99% (548/552) prepared to recommend the service. The sample was unrepresentative of the population of treated smokers in terms of eligibility for free prescriptions, ethnicity, age, type of treatment experienced, the type of advisor seen, medication use and end of treatment outcome. Satisfaction at week two was not related to abstinence at four weeks postquit. Limitations of the study and suggestions for service delivery are discussed.

Jumping the Hurdles for Smoking Cessation in Pregnant Aboriginal and Torres Strait Islander Women in Australia

Tobacco smoking perpetuates the disadvantages experienced by Aboriginal and Torres Strait Islander people in Australia. Tobacco smoking is a risk factor for poor maternal and infant outcomes in pregnancy. Over half of Aboriginal and Torres Strait Islander women smoke during pregnancy and few successfully quit. Aboriginal and Torres Strait Islander women face many intrinsic barriers to quitting such as low socioeconomic disadvantage and patterns of use in family networks. There are also several extrinsic hurdles surrounding current practice guidelines and policy that may limit success in reducing smoking rates among Aboriginal and Torres Strait Islander women during pregnancy: the use of the Stages of Change (SOC) model; delay in the use of nicotine replacement therapy (NRT); and the absence of subsidised intermittent NRT. A more proactive approach towards smoking cessation for pregnant Aboriginal and Torres Strait Islander women may be necessary, including moving away from the SOC model approach and subsidised provision of intermittent NRT. Comprehensive programs that take into account the family network and wider social context are also recommended.

How to Measure Client Satisfaction With Stop Smoking Services: A Pilot Project in the UK National Health Service

This pilot study aimed to develop a tool and methodology for measuring client satisfaction in UK National Health (NHS) Stop Smoking Services (SSS). A brief postcard questionnaire (measuring overall satisfaction with the service, willingness to recommend the service to others and smoking status) and a complete questionnaire (with 20 additional items measuring satisfaction with specific elements of the service) were developed. An NHS SSS mailed the postcard to 298 clients who had set a quit date in the previous quarter, they mailed the complete questionnaire to a subsample of 99 clients. Overall 34% (100/298) of those surveyed responded: 30% (90/298) for the card and 25% (25/99) for the questionnaire (15 people responded to both). Intraclass correlation coefficients (ICC) were found to be acceptable for both the overall service satisfaction item (ICC value = .43, p = .05) and the item regarding recommending the service to others (ICC-value = .83, p < .001). Hence the tool had reliability and at least face validity and the survey methodology proved practicable. The small modifications made to service delivery and the need for future research are discussed.

Acceptability and effectiveness for withdrawal symptom relief of a novel oral nicotine delivery device: a randomised crossover trial

RATIONALE

Existing nicotine replacement therapies (NRT) improve the chances of smoking cessation but are limited by either relatively slow nicotine absorption rates or unpleasant side effects, leaving scope for the development of more effective and acceptable products.

OBJECTIVES

This study aimed to test the acceptability and effectiveness for withdrawal symptom relief of a novel nicotine delivery device, the 'Nicotine Cannon' (NC), compared with three existing, equivalent products: the nicotine lozenge, mini-lozenge and nicotine inhalator.

METHODS

A repeated-measures crossover trial where participants were randomised to one of two conditions (1- or 10-h abstinence) and in each condition to one of 24 possible sequence permutations to test each product for 10 min was carried out. Standard sociodemographic and smoking characteristics were assessed as well as withdrawal and NRT use symptoms before, during and after NRT use and product satisfaction after use.

RESULTS

The results were similar across both durations of abstinence. The NC was significantly more effective than the inhalator in reducing withdrawal symptoms (F(3, 196)=3.5, p=0.015) and together with the mini-lozenge performed better than other NRT in alleviating urges to smoke (F(3, 563)=9.6, p<0.001) and desire for cigarettes within 10 min of use (F(3, 727)=26.1, p<0.001). The NC induced fewer adverse side effects than other NRT and was judged to be more enjoyable (F(3, 87)=13.56, p<0.001) and satisfying to use (F(3, 92)=12.35, p<0.001).

CONCLUSIONS

The 'Nicotine Cannon' is at least as effective as equivalent NRT in reducing withdrawal symptoms and more acceptable to users, suggesting that it would be a useful addition to existing NRT. The acceptability profile could make it particularly useful as a 'harm reduction' tool.

'The smoking toolkit study': a national study of smoking and smoking cessation in England

Background

Up-to-date data tracking of national smoking patterns and cessation-related behaviour is required to evaluate and inform tobacco control strategies. The Smoking Toolkit Study (STS) was designed for this role. This paper describes the methodology of the STS and examines as far as possible the representativeness of the samples.

Methods

The STS consists of monthly, cross sectional household interviews of adults aged 16 and over in England with smokers and recent ex-smokers in each monthly wave followed up by postal questionnaires three and six months later. Between November 2006 and December 2010 the baseline survey was completed by 90,568 participants. STS demographic, prevalence and cigarette consumption estimates are compared with those from the Health Survey for England (HSE) and the General Lifestyle Survey (GLF) for 2007-2009.

Results

Smoking prevalence estimates of all the surveys were similar from 2008 onwards (e.g 2008 STS = 22.0%, 95% C.I. = 21.4% to 22.6%, HSE = 21.7%, 95% C.I. = 20.9% to 22.6%, GLF = 20.8%, 95% C.I. = 19.7% to 21.9%), although there was heterogeneity in 2007 (chi-square = 50.30, p < 0.001). Some differences were observed across surveys within sociodemographic sub-groups, although largely in 2007. Cigarette consumption was virtually identical in all surveys and years.

Conclusion

There is reason to believe that the STS findings (see http://www.smokinginengland.info) are generalisable to the adult population of England.

The effects of plant traits and phylogeny on soil-to-plant transfer of 99Tc

Assessments of the behaviour of (99)Tc in terrestrial environments necessitate predicting soil-to-plant transfer. An experiment with 116 plant taxa showed that (99)Tc transfer to plants was positively related to plant dry weight but negatively related to % dry matter and age at exposure. Activities of (99)Tc analysed by hierarchical ANOVA coded with an angiosperm phylogeny revealed significant effects, with 55% of the variance between species explained at the Ordinal level and above. Monocots had significantly lower transfer of (99)Tc than Eudicots, within which Caryophyllales > Solanales > Malvales > Brassicales > Asterales > Fabales. There was a significant phylogenetic signal in soil-to-plant transfer of (99)Tc. This phylogenetic signal is used to suggest that, for example, a nominal Tc Transfer Factor of 5 could be adjusted to 2.3 for Monocots and 5.3 for Eudicots.

Promoting engagement with a Stop Smoking Service via pro-active telephone calls

OBJECTIVES

What proportion of smokers in a deprived area of London, contacted by telephone, are interested in quitting and accept a referral for cessation support?

METHODS

Current smokers from records of general practitioners (GPs) were telephoned; if interested in quitting they were offered a referral to the local Stop Smoking Service (SSS) and smoking status was assessed after 6 months.

RESULTS

Over half of current smokers (53%) were interested in receiving help to stop and 39% accepted a referral to the SSS. Six months later 21% of those contacted reported not smoking. Over one-quarter (28%) of those referred set a quit date with the service and 39% of these were recorded as abstinent four weeks after their quit date.

CONCLUSION

Calling smokers from GP lists appears to offer promise as a means of prompting quit attempts and ensuring that the chances of these quit attempts succeeding are maximized through attendance at NHS SSS.

PRACTICE IMPLICATIONS

GP records need to be accurate and maintained. Smoking patients can be contacted by telephone, informed about the availability of local cessation services and referred directly.

Provision of relapse prevention interventions in UK NHS Stop Smoking Services: a survey

Background

UK NHS Stop Smoking Services provide cost effective smoking cessation interventions but, as yet, there has been no assessment of their provision of relapse prevention interventions.

Methods

Electronic questionnaire survey of 185 UK Stop Smoking Services Managers.

Results

Ninety six Stop Smoking Service managers returned completed questionnaires (52% response rate). Of these, 58.3% (n = 56) ran NHS Stop Smoking Services which provided relapse prevention interventions for clients with the most commonly provided interventions being behavioural support: telephone (77%), group (73%), and individual (54%). Just under half (48%, n = 27) offered nicotine replacement therapy (NRT), 21.4% (n = 12) bupropion; 19.6% (n = 11) varenicline. Over 80% of those providing relapse prevention interventions do so for over six months. Nearly two thirds of all respondents thought it was likely that they would either continue to provide or commence provision of relapse prevention interventions in their services. Of the remaining respondents, 66.7% (n = 22) believed that the government focus on four-week quit rates, and 42.9% (14 services) believed that inadequate funding for provision of relapse prevention interventions, were major barriers to introducing these interventions into routine care.

Conclusions

Just over half of UK managers of NHS Stop Smoking Services who responded to the questionnaire reported that, in their services, relapse prevention interventions were currently provided for clients, despite, at that time, there being a weak evidence base for their effectiveness. The most commonly provided relapse prevention interventions were those for which there was least evidence. If these interventions are found to be effective, barriers would need to be removed before they would become part of routine care.

Consensus Report: 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis.

Online support for smoking cessation: a systematic review of the literature

AIM

To examine the efficacy and acceptability of online, interactive interventions for smoking cessation and to identify treatment effect moderators and mediators.

METHODS

A systematic review and meta-analysis of the literature (1990-2008) was conducted, finding 11 relevant randomized controlled trials. Data were extracted and risk ratios and risk differences estimated with a random effects model.

RESULTS

There was no evidence of publication bias. Included trials were of variable methodological quality. Web-based, tailored, interactive smoking cessation interventions were effective compared with untailored booklet or e-mail interventions [rate ratio (RR) 1.8; 95% confidence interval (CI) 1.4-2.3] increasing 6-month abstinence by 17% (95% CI 12-21%). No overall effect of interactive compared with static web-based interventions was detected but there was significant heterogeneity, with one study obtaining a clear effect and another failing to find one. Few moderating or mediating factors were evaluated in studies and those that were had little effect. Pooled results suggest that only interventions aimed at smokers motivated to quit were effective (RR 1.3, 95% CI 1.0-1.7). Fully automated interventions increased smoking cessation rates (RR 1.4, 95% CI 1.0-2.0), but evidence was less clear-cut for non-automated interventions. Overall, the web-based interventions evaluated were considered to be acceptable and user satisfaction was generally high.

CONCLUSION

Interactive, web-based interventions for smoking cessation can be effective in aiding cessation. More research is needed to evaluate the relative efficacy of interactive web-based interventions compared with static websites.