Parental Smoking and E-cigarette Use in Homes and Cars

OBJECTIVES

To determine how smoke-free and vape-free home and car policies differ for parents who are dual users of cigarettes and electronic cigarettes (e-cigarettes), who only smoke cigarettes, or who only use e-cigarettes. To identify factors associated with not having smoke-free or vape-free policies and how often smoke-free advice is offered at pediatric offices.

METHODS

Secondary analysis of 2017 parental interview data collected after their children's visit in 5 control practices participating in the Clinical Effort Against Secondhand Smoke Exposure trial.

RESULTS

Most dual users had smoke-free home policies, yet fewer had a vape-free home policies (63.8% vs 26.3%; P < .01). Dual users were less likely than cigarette users to have smoke-free car (P < .01), vape-free home (P < .001), or vape-free car (P < .001) policies. Inside cars, dual users were more likely than cigarette users to report smoking (P < .001), e-cigarette use (P < .001), and e-cigarette use with children present (P < .001). Parental characteristics associated with not having smoke-free or vape-free home and car policies include smoking ≥10 cigarettes per day, using e-cigarettes, and having a youngest child >10 years old. Smoke-free home and car advice was infrequently delivered.

CONCLUSIONS

Parents may perceive e-cigarette aerosol as safe for children. Dual users more often had smoke-free policies than vape-free policies for the home. Dual users were less likely than cigarette-only smokers to report various child-protective measures inside homes and cars. These findings reveal important opportunities for intervention with parents about smoking and vaping in homes and cars.

Combining Real-Time Ratings With Qualitative Interviews to Develop a Smoking Cessation Text Messaging Program for Primary Care Patients

Background

Text messaging (short message service, SMS) interventions show promise as a way to help cigarette smokers quit. Few studies have examined the effectiveness of text messaging (SMS) programs targeting smokers associated with primary care or hospital settings.

Objective

This study aimed to develop a text messaging (SMS) program targeting primary care smokers.

Methods

Adult smokers in primary care were recruited from February 2017 to April 2017. We sent patients 10 to 11 draft text messages (SMS) over 2 days and asked them to rate each message in real time. Patients were interviewed daily by telephone to discuss ratings, message preferences, and previous experiences with nicotine replacement therapy (NRT). Content analysis of interviews was directed by a step-wise text messaging (SMS) intervention development process and the Information-Motivation-Behavioral Skills model of medication adherence.

Results

We sent 149 text messages (SMS) to 15 patients. They replied with ratings for 93% (139/149) of the messages: 134 (96%, 134/139) were rated as clear or useful and 5 (4%, 5/139) as unclear or not useful. Patients’ preferences included the addition of graphics, electronic cigarette (e-cigarette) content, and use of first names. Regarding NRT, patients identified informational gaps around safety and effectiveness, preferred positively framed motivational messages, and needed behavioral skills to dose and dispose of NRT.

Conclusions

Patients recommended text message (SMS) personalization, inclusion of e-cigarette information and graphics, and identified barriers to NRT use.

Combining real-time ratings with telephone interviews is a feasible method for incorporating primary care patients’ preferences into a behavioral text messaging (SMS) program.

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

INTRODUCTION

Most smokers see a physician each year, but few use any assistance when they try to quit. Text messaging programs improve smoking cessation in community and school settings; however, their efficacy in a primary care setting is unclear. The current trial assesses the feasibility and preliminary clinical outcomes of text messaging and mailed nicotine replacement therapy (NRT) among smokers in primary care.

METHODS

In this single-center pilot randomized trial, eligible smokers in primary care are offered brief advice by phone and randomly assigned to one of four interventions: (1) Brief advice only, (2) text messages targeted to primary care patients and tailored to quit readiness, (3) a 2-week supply of nicotine patches and/or lozenges (NRT), and (4) both text messaging and NRT. Randomization is stratified by practice and intention to quit. The text messages (up to 5/day) encourage those not ready to quit to practice a quit attempt, assist those with a quit date through a quit attempt, and promote NRT use. The 2-week supply of NRT is mailed to patients' homes.

RESULTS

Feasibility outcomes include recruitment rates, study retention, and treatment adherence. Clinical outcomes are assessed at 1, 2, 6, and 12-weeks post-enrollment. The primary outcome is ≥1self-reported quit attempt(s). Secondary clinical outcomes include self-reported past 7- and 30-day abstinence, days not smoked, NRT adherence, and exhaled carbon monoxide.

CONCLUSIONS

This pilot assesses text messaging plus NRT, as a proactively offered intervention for smoking cessation support in smokers receiving primary care and will inform full-scale randomized trial planning.

TRIAL REGISTRATION

ClinicalTrials.govNCT03174158.

Parental Dual Use of e-Cigarettes and Traditional Cigarettes

BACKGROUND

E-cigarettes are growing in popularity. Dual use of e-cigarettes and cigarettes is an increasingly common practice, but little is known about patterns of dual use in parents. We sought to describe smoking-related behaviors among dual-users.

METHODS

Parent exit surveys were conducted following their child's visit in 5 control pediatric practices in 5 states participating in the Clinical Effort Against Secondhand Smoke Exposure trial. We examined factors associated with dual use of e-cigarettes and cigarettes versus cigarette-only smokers, assessed by self-report.

RESULTS

Of 1382 smokers or recent quitters screened after their child's visit between April and October 2017, 943 (68%) completed the survey. Of these, 727 parents reported current use of cigarettes; of those, 81 (11.1%) also reported e-cigarette use, meeting the definition of dual use. Compared with cigarette-only smokers, dual users were more likely to have a child younger than 1 year old, planned to quit in the next 6 months, and had tried to quit in the past (had a quit attempt in the past 3 months, called the quitline, or used medicine to quit in the past 2 years; P < .05 for each).

CONCLUSIONS

Parents who use both e-cigarettes and cigarettes may have greater rates of contemplating smoking cessation than parents who only smoke cigarettes. These parents may be using e-cigarettes for harm reduction or as a step toward cessation. Identification of these parents may provide an opportunity to deliver effective treatment, including nicotine-replacement therapies that do not expose infants and children to e-cigarette aerosol.

Smoking Cessation After Hospital Discharge: Factors Associated With Abstinence

Hospitalization offers tobacco smokers an opportunity to quit smoking, but factors associated with abstinence from tobacco after hospital discharge are poorly understood. We analyzed data from a multisite, randomized controlled trial testin a smoking cessation intervention for 1,357 hospitalized cigaretts smokers who planned to quit. Using multiple logistic regression, we assessed factors identifiable in the hospital that were independently associated with biochemically confirmed tobacco abstinence 6 months after discharge. Biochemically confirmed abstinence at 6 months (n = 218, 16%) was associated with a smoking-related primary discharge diagnosis (Adjusted Odds Ratio [AOR] = 1.98, 95% CI: 1.41-2.77), greater confidence in the ability to quit smoking (AOR - 1.31, 95% CI: 1.07-1.60), and stronger intention to quit (plan to quit after discharge vs. try to quit; AOR = 1.68, CI: 1.19-2.38). In conclusion, smokers hospitalized with a tobacco-related illness and those with greater confidence and intention to quit after discharge are more likely to sustain abstinence in the long term. Hospital clinicians' efforts to promote smoking cessation should target smokers' confidence and motivation to quit.

Prevention and Treatment of Tobacco Use: JACC Health Promotion Series

Tobacco use is the leading preventable cause of death worldwide and is a major risk factor for cardiovascular disease (CVD). Both prevention of smoking initiation among youth and smoking cessation among established smokers are key for reducing smoking prevalence and the associated negative health consequences. Proven tobacco cessation treatment includes pharmacotherapy and behavioral support, which are most effective when provided together. First-line medications (varenicline, bupropion, and nicotine replacement) are effective and safe for patients with CVD. Clinicians who care for patients with CVD should give as high a priority to treating tobacco use as to managing other CVD risk factors. Broader tobacco control efforts to raise tobacco taxes, adopt smoke-free laws, conduct mass media campaigns, and restrict tobacco marketing enhance clinicians' actions working with individual smokers.

Financial Strain, Quit Attempts, and Smoking Abstinence Among U.S. Adult Smokers

INTRODUCTION

Cigarette smoking is substantially more prevalent and rates of smoking cessation are lower in low-SES adults. Financial strain may be one explanation for this. This study assessed the association between financial strain, quit attempts, and successful smoking cessation among adult smokers in the U.S.

METHODS

Longitudinal data on adult current smokers (aged ≥18 years) from Waves 1 and 2 of the nationally representative Population Assessment of Tobacco and Health Study (2013-2015) were analyzed in 2017. Negative binomial regression and logistic regression models assessed the association between financial strain and (1) quit attempts and (2) cigarette abstinence, adjusting for important confounders.

RESULTS

Smokers with financial strain made more quit attempts than smokers without financial strain (adjusted incidence-rate ratio=1.34, 95% CI=1.07, 1.68), but financial strain was not associated with smoking abstinence at follow-up (AOR=0.86, 95% CI=0.70, 1.05). Low income was associated with less smoking abstinence at follow-up (AOR=0.66, 95% CI=0.50, 0.87, for <100% federal poverty level; AOR=0.64, 95% CI=0.48, 0.85, for 100%-199% of federal poverty level). Smokers with baseline financial strain who quit at follow-up had lower odds of financial strain at follow-up (AOR=0.57, 95% CI=0.36, 0.89).

CONCLUSIONS

Financially strained smokers made slightly more quit attempts than non-strained smokers but were no more likely to successfully quit. Low-income (less than 200% of the federal poverty level) smokers were less likely to quit than higher-income smokers, suggesting that financial strain alone may not explain the low quit rates in this population. Further efforts are needed to increase the success of quit attempts in low-income and financially strained smokers.

Integration of tobacco cessation and tuberculosis management by NGOs in urban India: a mixed-methods study

Setting and objectives: Tobacco use compromises tuberculosis (TB) treatment outcomes. Tobacco cessation is beneficial to TB patients at the individual level and from the perspective of a larger spectrum of non-communicable diseases associated with tobacco use. We assessed feasibility, effectiveness and provider perceptions on integrating brief tobacco cessation advice into routine TB care by DOTS providers from 27 TB treatment centres run by three non-governmental organisations (NGOs) in urban India. Design: A mixed-methods study (triangulation design) involving analysis of programme data and semi-structured interviews (quantitative) and thematic analysis of focus group discussions of TB treatment providers (qualitative) regarding brief advice and cessation support provided to self-reported tobacco users from August 2015 to July 2017. Results: All 27 centres initiated tobacco cessation. Of 2132 registered TB patients, 377 (18%) were tobacco users, 333 (88%) of whom used smokeless tobacco. There was a progressive drop in documentation of tobacco status at each visit, reaching respectively 36% and 30% at the end of treatment for new and retreatment TB patients. Seven-day point prevalence abstinence at 6 months was 32% among new and 15% among retreatment cases. Enablers for integration included NGO collaboration, supervision and capacity building. Challenges included providers spending 15-45 min per patient (10 min recommended), multiple addictions, documentation load, self-reporting and social normalisation of tobacco. Conclusions: Integration of tobacco cessation into routine TB care in an urban NGO setting was feasible, although without continued support, rigour in documentation declined. This should be scaled up with special attention paid to tackling smokeless tobacco and related operational challenges.

Electronic cigarette use patterns and reasons for use among smokers recently diagnosed with cancer

Many patients with cancer use electronic cigarettes (e‐cigarettes), yet little is known about patterns and reasons for use. Using cross‐sectional baseline data from a randomized controlled trial, we aimed to describe prevalence and correlates of e‐cigarette use, frequency of use, and reasons for use among smokers recently diagnosed with cancer. Participants (n = 302) included adults (age ≥18 years) recently diagnosed with varied cancer types who smoked ≥1 cigarette within the past 30‐d from two US academic medical centers. Participants reported ever and current e‐cigarette use, and current e‐cigarette users reported days of e‐cigarette use and the main reason for use. We compared current, former, and never e‐cigarette users by sociodemographics, cancer type, medical comorbidities, smoking behaviors, attitudes, and emotional symptoms, and described use among current e‐cigarette users. Of smokers recently diagnosed with cancer, 49% (n = 149) reported ever e‐cigarette use and 19% (n = 56) reported current use. Of current e‐cigarette users, 29% (n = 16) reported daily use. Current e‐cigarette users did not differ from former and never e‐cigarette users by cancer type, smoking behaviors, or emotional symptoms. Women were more likely to be current users than never users, and current e‐cigarette users had less education than former users. Most current e‐cigarette users reported using them to help quit smoking (75%). One in five smokers with cancer report current e‐cigarette use, but most are not using e‐cigarettes daily. The majority report using e‐cigarettes to quit smoking. E‐cigarette use by patients with cancer appears to reflect a desire to quit smoking.

Cost-Effectiveness of a Health System-Based Smoking Cessation Program

Introduction

Project CLIQ (Community Link to Quit) was a proactive population-outreach strategy using an electronic health records-based smoker registry and interactive voice recognition technology to connect low- to moderate-income smokers with cessation counseling, medications, and social services. A randomized trial demonstrated that the program increased cessation. We evaluated the cost-effectiveness of CLIQ from a provider organization's perspective if implemented outside the trial framework.

Methods

We calculated the cost, cost per smoker, incremental cost per additional quit, and, secondarily, incremental cost per additional life year saved of the CLIQ system compared to usual care using data from a 2011-2013 randomized trial assessing the effectiveness of the CLIQ system. Sensitivity analyses considered economies of scale and initial versus ongoing costs.

Results

Over a 20-month period (the duration of the trial) the program cost US $283 027 (95% confidence interval [CI] $209 824-$389 072) more than usual care in a population of 8544 registry-identified smokers, 707 of whom participated in the program. The cost per smoker was $33 (95% CI 28-40), incremental cost per additional quit was $4137 (95% CI $2671-$8460), and incremental cost per additional life year saved was $7301 (95% CI $4545-$15 400). One-time costs constituted 28% of costs over 20 months. Ongoing costs were dominated by personnel costs (71% of ongoing costs). Sensitivity analyses showed sharp gains in cost-effectiveness as the number of identified smokers increased because of the large initial costs.

Conclusions

The CLIQ system has favorable cost-effectiveness compared to other smoking cessation interventions. Cost-effectiveness will be greatest for health systems with high numbers of smokers and with the high smoker participation rates.

Implications

Health information systems capable of establishing registries of patients who are smokers are becoming more prevalent. This economic analysis illustrates the cost implications for health care systems adopting a proactive tobacco treatment outreach strategy for low- and middle-income smokers. We find that under many circumstances, the CLIQ system has a favorable cost-per-quit compared to other population-based tobacco treatment strategies. The strategy could be widely disseminable if health systems leverage economies of scale.

Improvements in health-related quality of life among smokers who quit after hospitalization

Few rigorous longitudinal assessments have examined health-related quality of life (HRQoL) changes after smoking cessation, especially among recently-hospitalized smokers. We compared the change in HRQoL between those who did or did not quit smoking 6 months after hospital discharge. Participants were 1357 smokers recruited for a cessation trial between 2012 and 2014 while hospitalized at two hospitals in Massachusetts and one in Pennsylvania. Cessation was defined as biochemically confirmed 7-day point prevalence abstinence at 6 months or as self-reported continuous abstinence at 1, 3, or 6 months post discharge. HRQoL measures included a single-item global health measure (SF1); the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) screening tool for psychological distress; and the EQ-5D-5L health utilities measure. Multivariable models controlled for age, sex, race, education, insurance, study site, study arm, discharge diagnoses, and baseline HRQoL. Improvements in HRQoL were evident in the first month after discharge among those achieving abstinence compared to continuing smokers. At 6 months post-discharge, those with biochemically confirmed cessation were 30% more likely to report at least good health by the SF1 (aRR 95% CI 1.14-1.45), 19% less likely to screen positive for psychological distress (aRR, 95% CI 0.68-0.93), and had EQ-5D-5L health utility scores 0.05 points (95% CI 0.02-0.08) higher than continuing smokers. Results were similar when assessed as a function of self-reported cessation. Hospital-initiated smoking cessation is associated with rapid statistically and clinically significant improvements in a range of HRQoL measures, providing an additional tool clinicians and health systems could use to encourage smoking cessation.

Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization: A Prospective Study

BACKGROUND

Many smokers report using e-cigarettes to help them quit smoking, but whether e-cigarettes aid cessation efforts is uncertain.

OBJECTIVE

To determine whether e-cigarette use after hospital discharge is associated with subsequent tobacco abstinence among smokers who plan to quit and are advised to use evidence-based treatment.

DESIGN

Secondary data analysis of a randomized controlled trial. (ClinicalTrials.gov: NCT01714323 [parent trial]).

SETTING

3 hospitals.

PARTICIPANTS

1357 hospitalized adult cigarette smokers who planned to stop smoking, received tobacco cessation counseling in the hospital, and were randomly assigned at discharge to a tobacco treatment recommendation (control) or free tobacco treatment (intervention).

MEASUREMENTS

Self-reported e-cigarette use (exposure) was assessed 1 and 3 months after discharge; biochemically validated tobacco abstinence (outcome) was assessed 6 months after discharge.

RESULTS

Twenty-eight percent of participants used an e-cigarette within 3 months after discharge. In an analysis of 237 propensity score-matched pairs, e-cigarette users were less likely than nonusers to abstain from tobacco use at 6 months (10.1% vs. 26.6%; risk difference, -16.5% [95% CI, -23.3% to -9.6%]). The association between e-cigarette use and quitting varied between intervention patients, who were given easy access to conventional treatment (7.7% vs. 29.8%; risk difference, -22.1% [CI, -32.3% to -11.9%]), and control patients, who received only treatment recommendations (12.0% vs. 24.1%; risk difference, -12.0% [CI, -21.2% to 2.9%]) (P for interaction = 0.143).

LIMITATIONS

Patients self-selected e-cigarette use. Unmeasured confounding is possible in an observational study.

CONCLUSION

During 3 months after hospital discharge, more than a quarter of smokers attempting to quit used e-cigarettes, mostly to aid cessation, but few used them regularly. This pattern of use was associated with less tobacco abstinence at 6 months than among smokers who did not use e-cigarettes. Additional study is needed to determine whether regular use of e-cigarettes aids or hinders smoking cessation.

PRIMARY FUNDING SOURCE

National Heart, Lung, and Blood Institute.

Weight gain after smoking cessation: more data to refute concerns

Take home figure.

Subsistence difficulties are associated with more barriers to quitting and worse abstinence outcomes among homeless smokers: evidence from two studies in Boston, Massachusetts

Background

Three-quarters of homeless people smoke cigarettes. Competing priorities for shelter, food, and other subsistence needs may be one explanation for low smoking cessation rates in this population. We analyzed data from two samples of homeless smokers to examine the associations between subsistence difficulties and 1) smoking cessation readiness, confidence, and barriers in a cross-sectional study, and 2) smoking abstinence during follow-up in a longitudinal study.

Methods

We conducted a survey of homeless smokers (N = 306) in 4/2014–7/2014 and a pilot randomized controlled trial (RCT) for homeless smokers (N = 75) in 10/2015–6/2016 at Boston Health Care for the Homeless Program. In both studies, subsistence difficulties were characterized as none, low, or high based on responses to a 5-item scale assessing the frequency of past-month difficulty finding shelter, food, clothing, a place to wash, and a place to go to the bathroom. Among survey participants, we used linear regression to assess the associations between subsistence difficulty level and readiness to quit, confidence to quit, and a composite measure of perceived barriers to quitting. Among RCT participants, we used repeated-measures logistic regression to examine the association between baseline subsistence difficulty level and carbon monoxide-defined brief smoking abstinence assessed 14 times over 8 weeks of follow-up. Analyses adjusted for demographic characteristics, substance use, mental illness, and nicotine dependence.

Results

Subsistence difficulties were common in both study samples. Among survey participants, greater subsistence difficulties were associated with more perceived barriers to quitting (p < 0.001) but not with cessation readiness or confidence. A dose-response relationship was observed for most barriers, particularly psychosocial barriers. Among RCT participants, greater baseline subsistence difficulties predicted less smoking abstinence during follow-up in a dose-response fashion. In adjusted analyses, individuals with the highest level of subsistence difficulty had one-third the odds of being abstinent during follow-up compared to those without subsistence difficulties (OR 0.33, 95% CI 0.11–0.93) despite making a similar number of quit attempts.

Conclusions

Homeless smokers with greater subsistence difficulties perceive more barriers to quitting and are less likely to do so despite similar readiness, confidence, and attempts. Future studies should assess whether addressing subsistence difficulties improves cessation outcomes in this population.

Trial registration

ClinicalTrials.gov: NCT02565381.

Smoking-Cessation Efforts by US Adult Smokers with Medical Comorbidities

BACKGROUND

Continued cigarette smoking by individuals with chronic medical diseases can adversely affect their symptoms, disease progression, and mortality. We assessed the association between medical comorbidities and smoking-cessation efforts among US adult smokers.

METHODS

We analyzed cross-sectional data from 12,494 past-year cigarette smokers aged ≥18 years from Wave 1 (2013-2014) of the nationally representative Population Assessment of Tobacco and Health study. We assessed the association between self-reported medical comorbidities and past-year quit attempts, use of evidence-based smoking-cessation treatment or electronic cigarettes, and successful smoking cessation using logistic regression, adjusting for sociodemographics, insurance status, geographic region, and having a past-year doctor visit.

RESULTS

In the study sample, 39% were aged 18 to 34 years, 45% were female, 70% were non-Hispanic white, and 48% reported ≥1 comorbidity. Smokers with any comorbidity, compared with those without comorbidities, had higher odds of trying to quit (adjusted odds ratio, 1.19; 95% confidence interval, 1.08-1.30), but no higher likelihood of quitting success. Having more medical comorbidities was associated with increased odds of trying to quit. Smokers with a comorbidity used evidence-based treatment more often than smokers without comorbidities (43% vs 26%); use of e-cigarettes to quit was similar between smokers with and without comorbidities (27% vs 28%).

CONCLUSIONS

Adult smokers with chronic medical diseases try to quit and use evidence-based tobacco-cessation treatment more often than smokers without comorbidities, but they are no more likely to quit, suggesting that their quit attempts are less likely to succeed. Smokers with medical comorbidities may require more intensive, prolonged, and repeated treatment to stop smoking.

Patient navigation for lung cancer screening among current smokers in community health centers a randomized controlled trial

Annual chest computed tomography (CT) can decrease lung cancer mortality in high-risk individuals. Patient navigation improves cancer screening rates in underserved populations. Randomized controlled trial was conducted from February 2016 to January 2017 to evaluate the impact of a patient navigation program on lung cancer screening (LCS) among current smokers in five community health centers (CHCs) affiliated with an academic primary care network. We randomized 1200 smokers aged 55-77 years to intervention (n = 400) or usual care (n = 800). Navigators contacted patients to determine LCS eligibility, introduce shared decision making about screening, schedule appointments with primary care physicians (PCPs), and help overcome barriers to obtaining screening and follow-up. Control patients received usual care. The main outcome was the proportion of patients who had any chest CT. Secondary outcomes were the proportion of patients contacted, proportion receiving LCS CTs, screening results and number of lung cancers diagnosed. Of the 400 intervention patients, 335 were contacted and 76 refused participation. Of the 259 participants, 124 (48%) were ineligible for screening; 119 had smoked <30 pack-years, and five had competing comorbidities. Among the 135 eligible participants in the intervention group, 124 (92%) had any chest CT performed. In intention-to-treat analyses, 124 intervention patients (31%) had any chest CT versus 138 control patients (17.3%, P < 0.001). LCS CTs were performed in 94 intervention patients (23.5%) versus 69 controls (8.6%, P < 0.001). A total of 20% of screened patients required follow-up. Lung cancer was diagnosed in eight intervention (2%) and four control (0.5%) patients. A patient navigation program implemented in CHCs significantly increased LCS among high-risk current smokers.

Feasibility of a proactive text messaging intervention for smokers in community health centers

Background

Few smokers receive evidence-based cessation services during primary care visits.

Objective

We aimed to assess the feasibility of a proactive text messaging program for primary care patients who smoke.

Methods

We used electronic health records to identify smokers who had a mobile phone number listed from two community health centers in Massachusetts. Between March 2014 and June 2015, patients were screened by their primary care physician and then sent a proactive text message inviting them to enroll by texting back. Patients who opted in were asked about their readiness to quit. The text message program included messages from the QuitNowTXT library and novel content for smokers who were not ready to quit.

Results

Among 949 eligible smokers, 88 (9.3%) enrolled after receiving a single proactive text message. Compared with those who did not enroll, enrollees were more often female (54/88, 61% vs 413/861, 48.0%, P=.02), but otherwise did not differ in age, race, insurance status, or comorbidities. In all, 28% (19/67) of enrollees reported they were not ready to quit in the next 30 days, 61% (41/67) were ready to quit, and 11% (7/67) already quit. The median time in the program was 9 days (interquartile range 2-32 days). Of current smokers, 25% (15/60) sent one or more keyword requests to the server. These did not differ by readiness to quit.

Conclusions

A proactively delivered text messaging program targeting primary care patients who smoke was feasible and engaged both smokers ready to quit and those not ready to quit. This method shows promise as part of a population health model for addressing tobacco use outside of the primary care office.

Accuracy of self-reported smoking abstinence in clinical trials of hospital-initiated smoking interventions

AIMS

To estimate the prevalence and predictors of failed biochemical verification of self-reported abstinence among participants enrolled in trials of hospital-initiated smoking cessation interventions.

DESIGN

Comparison of characteristics between participants who verified and those who failed to verify self-reported abstinence.

SETTINGS

Multi-site randomized clinical trials conducted between 2010 and 2014 in hospitals throughout the United States.

PARTICIPANTS

Recently hospitalized smokers who reported tobacco abstinence 6 months post-randomization and provided a saliva sample for verification purposes (n = 822).

MEASUREMENTS

Outcomes were salivary cotinine-verified smoking abstinence at 10 and 15 ng/ml cut-points. Predictors and correlates included participant demographics and tobacco use; hospital diagnoses and treatment; and study characteristics collected via surveys and electronic medical records.

FINDINGS

Usable samples were returned by 69.8% of the 1178 eligible trial participants who reported 7-day point prevalence abstinence. The proportion of participants verified as quit was 57.8% [95% confidence interval (CI) = 54.4, 61.2; 10 ng/ml cut-off] or 60.6% (95% CI = 57.2, 63.9; 15 ng/ml). Factors associated independently with verification at 10 ng/ml were education beyond high school education [odds ratio (OR) = 1.51; 95% CI = 1.07, 2.11], continuous abstinence since hospitalization (OR = 2.82; 95% CI = 2.02, 3.94), mailed versus in-person sample (OR = 3.20; 95% CI = 1.96, 5.21) and race. African American participants were less likely to verify abstinence than white participants (OR = 0.64; 95% CI = 0.44, 0.93). Findings were similar for verification at 15 ng/ml. Verification rates did not differ by treatment group.

CONCLUSIONS

In the United States, high rates (40%) of recently hospitalized smokers enrolled in smoking cessation trials fail biochemical verification of their self-reported abstinence.

Smoking Cessation Pharmacotherapy Among Smokers Hospitalized for Coronary Heart Disease

This study uses data from the Premier Alliance database to assess factors associated with the use of smoking cessation pharmacotherapy in smokers hospitalized for coronary heart disease.