701
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Prod'hom S, Locatelli I, Giraudon K, Marques-Vidal P, Clair C, Bize R, Cornuz J. Predictors of weight change in sedentary smokers receiving a standard smoking cessation intervention. Nicotine Tob Res 2012; 15:910-6. [PMID: 23048177 DOI: 10.1093/ntr/nts217] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Quitting smoking is associated with weight gain, which may threaten motivation to engage or sustain a quit attempt. The pattern of weight gained by smokers treated according to smoking cessation guidelines has been poorly described. We aimed to determine the weight gained after smoking cessation and its predictors, by smokers receiving individual counseling and nicotine replacement therapies for smoking cessation. METHODS We performed an ancillary analysis of a randomized controlled trial assessing moderate physical activity as an aid for smoking cessation in addition to standard treatment in sedentary adult smokers. We used mixed longitudinal models to describe the evolution of weight over time, thus allowing us to take every participant into account. We also fitted a model to assess the effect of smoking status and reported use of nicotine replacement therapy at each time point. We adjusted for intervention group, sex, age, nicotine dependence, and education. RESULTS In the whole cohort, weight increased in the first 3 months, and stabilized afterwards. Mean 1-year weight gain was 3.3kg for women and 3.9kg for men (p = .002). Higher nicotine dependence and male sex were associated with more weight gained during abstinence. Age over median was associated with continuing weight gain during relapse. There was a nonsignificant trend toward slower weight gain with use of nicotine replacement therapies. CONCLUSION Sedentary smokers receiving a standard smoking cessation intervention experience a moderate weight gain, limited to the first 3 months. Older age, male sex, and higher nicotine dependence are predictors of weight gain.
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Affiliation(s)
- Sylvain Prod'hom
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
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702
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Minas M, Apostolidou E, Goudouva I, Makris E, Gourgoulianis KI, Hatzoglou C. Clinical phenotypes related to smoking cessation. J Subst Abuse Treat 2012; 44:288-94. [PMID: 23021906 DOI: 10.1016/j.jsat.2012.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 06/28/2012] [Accepted: 08/03/2012] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of the current study is the identification of clinical phenotypes of patients visiting a specialized smoking cessation center and the determination of smoking cessation rate for each phenotype, 1 year after the initial evaluation. METHODS Seven hundred eighty-three smokers who visited the outpatient clinic were included in the study. Demographic data, smoking habits, tobacco dependence and comorbidities were recorded. Smoking cessation rates and carbon monoxide levels were determined 1 year after the initial evaluation. RESULTS The overall smoking cessation rate 1 year after the initial evaluation was 32.3%. Four distinct phenotypes were identified. The first one included mainly young women with low tobacco dependence and allergic profile. The second and the third ones included mainly men with high tobacco dependence, without comorbidities, treated with varenicline and bupropione SR, respectively. The fourth one included mainly older men with high tobacco dependence and smoking related comorbidities. Smoking cessation rates for each phenotype were 33.8, 39.4, 23.3, and 24.6%, respectively. CONCLUSION Patients visiting a specialized smoking cessation center can be categorized in different phenotypes. Phenotyping may lead to a more personalized approach concerning smoking cessation.
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Affiliation(s)
- Markos Minas
- Respiratory Medicine Department, University of Thessaly Medical School, Larissa, Biopolis 41110, Greece
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703
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Breivogel C, Jamerson B. Passion flower extract antagonizes the expression of nicotine locomotor sensitization in rats. PHARMACEUTICAL BIOLOGY 2012; 50:1310-1316. [PMID: 22873194 DOI: 10.3109/13880209.2012.674535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CONTEXT Nicotine, a bioactive component of tobacco, is highly addictive. Numerous therapies have been developed or are currently under investigation for smoking cessation, and all have met with limited success and/or side effects, indicating the need for additional therapies. OBJECTIVE This study examines the ability of a commerically-available aqueous extract of Passiflora incarnata Linn. (Passifloraceae) to ameliorate the signs of nicotine sensitization using a rat model. MATERIALS AND METHODS Rats were administered 0.4 mg/kg nicotine or vehicle once a day for four consecutive days. Nicotine adminstration produces sensitization of locomotor activity, a phenomenon implicated in the development of nicotine dependence. On the fifth day, locomotor activity of the subjects was monitored as rats from each treatment group were administered 800 mg/kg of Passiflora incarnata extract (or its vehicle) followed by a challenge dose of 0.4 mg/kg nicotine. RESULTS When given to rats sensitized to nicotine for 4 days, the challenge dose of nicotine increased locomotor activity by more than 2-fold over activity following nicotine challenge in rats treated with vehicle during the sensitization phase. The difference was significant from 15-40 min after nicotine administration. Rats sensitized to nicotine then treated with Passiflora incarnata extract prior to the nicotine challenge exhibited a level of locomotor activity the same as the vehicle-treated controls. DISCUSSION Passiflora incarnata extract did antagonize the expression of nicotine locomotor sensitization. CONCLUSION Passiflora incarnata extract should be examined in future studies to evaluate its potential for treating nicotine addiction in humans.
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Affiliation(s)
- Chris Breivogel
- Department of Pharmaceutical Sciences, Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC 27506, USA.
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704
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O'Donnell MP. We are beginning to speak with one voice: consensus statement on wellness incentives. Am J Health Promot 2012; 27:iv-vii. [PMID: 22950936 DOI: 10.4278/ajhp.27.1.iv] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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705
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Lynam I, Catley D, Harris KJ, Goggin K, Berkley-Patton J, Thomas J. African American smokers' intention to use pharmacotherapy for cessation. Am J Health Behav 2012; 36:615-27. [PMID: 22584089 PMCID: PMC3356924 DOI: 10.5993/ajhb.36.5.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To use the theory of planned behavior to identify predictors of intentions to use cessation aids when quitting smoking. METHODS African American smokers completed a survey to assess intentions, attitudes, and normative and control beliefs regarding the use of smoking cessation aids. RESULTS Participants held mildly positive attitudes regarding the use of cessation aids. Beliefs related to the utility of aids, support of referents, and accessibility of a doctor were most strongly associated with intention to use cessation aids. CONCLUSIONS African American smokers may be amenable to the use of cessation aids, and specific beliefs may be targets for intervention.
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Affiliation(s)
- Ian Lynam
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA.
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706
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Jemal A, Ma J, Rosenberg PS, Siegel R, Anderson WF. Increasing lung cancer death rates among young women in southern and midwestern States. J Clin Oncol 2012; 30:2739-44. [PMID: 22734032 PMCID: PMC3402885 DOI: 10.1200/jco.2012.42.6098] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 05/07/2012] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Previous studies reported that declines in age-specific lung cancer death rates among women in the United States abruptly slowed in women younger than age 50 years (ie, women born after the 1950s). However, in view of substantial geographic differences in antitobacco measures and sociodemographic factors that affect smoking prevalence, it is unknown whether this change in the trend was similar across all states. METHODS We examined female age-specific lung cancer death rates (1973 through 2007) by year of death and birth in each state by using age-period-cohort models. Cohort relative risks adjusted for age and period effects were used to compare the lung cancer death rate for a given birth cohort to a referent birth cohort (ie, the 1933 cohort herein). RESULTS Age-specific lung cancer death rates declined continuously in white women in California, but the rates declined less quickly or even increased in the remaining states among women younger than age 50 years and women born after the 1950s, especially in several southern and midwestern states. For example, in some southern states (eg, Alabama), lung cancer death rates among women born in the 1960s were approximately double those of women born in the 1930s. CONCLUSION The unfavorable lung cancer trend in white women born after circa 1950 in southern and midwestern states underscores the need for additional interventions to promote smoking cessation in these high-risk populations, which could lead to more favorable future mortality trends for lung cancer and other smoking-related diseases.
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Affiliation(s)
- Ahmedin Jemal
- Surveillance Research Program, American Cancer Society, 250 Williams St, Atlanta, GA 30303, USA.
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707
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Knowledge, Attitudes, and Behavior Toward Smoking Cessation among Hospital Pharmacists in Taiwan. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.jecm.2012.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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708
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Athanasakis K, Igoumenidis M, Karampli E, Vitsou E, Sykara G, Kyriopoulos J. Cost-effectiveness of varenicline versus bupropion, nicotine-replacement therapy, and unaided cessation in Greece. Clin Ther 2012; 34:1803-14. [PMID: 22818870 DOI: 10.1016/j.clinthera.2012.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/05/2012] [Accepted: 07/05/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Varenicline was designed to relieve symptoms of nicotine withdrawal, including cigarette craving, and to block the reinforcing effects of continued nicotine use. The cost-effectiveness of varenicline in some countries has not been studied. OBJECTIVE The aim of this study was to compare the cost-effectiveness of varenicline to that of bupropion, nicotine-replacement therapy (NRT), and unaided cessation in the Greek health care setting. The analysis takes into account a societal security (third-party payer) perspective. METHODS To perform the analyses of the benefits of smoking cessation in terms of smoking-related morbidity, mortality, and associated medical costs, a Markov model was used that simulated the progress of a hypothetical cohort of current smokers making a single attempt to quit smoking at the beginning of the timeframe of the analysis. The robustness of the results was assessed using a series of 1-way sensitivity analyses. RESULTS Varenicline was associated with the potential prevention of 14.1, 14.2, and 35.1 additional cases of the 4 smoking-related diseases incorporated into the model, per 1000 smokers willing to quit, versus bupropion, NRT, and unaided cessation, respectively. Potentially avoided smoking-related deaths with varenicline were estimated at 3.24, 3.26, and 7.5 per 1000 quitters versus the 3 comparators. Varenicline led to a potential gain of 33.78, 33.91, and 83.97 QALYs per 1000 persons willing to make a quit attempt versus the 3 comparators. Varenicline was associated with cost-savings against both active comparators for the lifetime horizon. Overall, the cost per additional quitter with varenicline, considering only the costs of the smoking-cessation strategy, was €2659 (€1015) for a lifetime horizon compared with bupropion (NRT); however, when all direct costs were incorporated into the analysis, varenicline was cost-saving. CONCLUSION The findings from the present study suggest that, compared with the widely used treatment options bupropion and NRT, as well as unaided cessation, varenicline may enhance smoking-cessation treatment outcomes while substantially reducing the overall costs of smoking to the health care system.
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Affiliation(s)
- Kostas Athanasakis
- Department of Health Economics, National School of Public Health, Athens, Greece
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709
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Kunzel B, Cabalza J, Faurot M, Solomon T, Nieh P, Pattaras J, Master VA, Ogan K. Prospective Pilot Study of Smoking Cessation in Patients Undergoing Urologic Surgery. Urology 2012; 80:104-9. [DOI: 10.1016/j.urology.2012.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 04/10/2012] [Accepted: 04/12/2012] [Indexed: 11/24/2022]
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710
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García-Rodríguez O, Pericot-Valverde I, Gutiérrez-Maldonado J, Ferrer-García M, Secades-Villa R. Validation of smoking-related virtual environments for cue exposure therapy. Addict Behav 2012; 37:703-8. [PMID: 22385732 DOI: 10.1016/j.addbeh.2012.02.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 12/23/2011] [Accepted: 02/13/2012] [Indexed: 11/18/2022]
Abstract
Craving is considered one of the main factors responsible for relapse after smoking cessation. Cue exposure therapy (CET) consists of controlled and repeated exposure to drug-related stimuli in order to extinguish associated responses. The main objective of this study was to assess the validity of 7 virtual reality environments for producing craving in smokers that can be used within the CET paradigm. Forty-six smokers and 44 never-smokers were exposed to 7 complex virtual environments with smoking-related cues that reproduce typical situations in which people smoke, and to a neutral virtual environment without smoking cues. Self-reported subjective craving and psychophysiological measures were recorded during the exposure. All virtual environments with smoking-related cues were able to generate subjective craving in smokers, while no increase was observed for the neutral environment. The most sensitive psychophysiological variable to craving increases was heart rate. The findings provide evidence of the utility of virtual reality for simulating real situations capable of eliciting craving. We also discuss how CET for smoking cessation can be improved through these virtual tools.
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711
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Lynam I, Catley D, Harris KJ, Goggin K, Berkley-Patton J, Thomas J. African American smokers' intention to use pharmacotherapy for cessation. Am J Health Behav 2012. [PMID: 22584089 DOI: 10.5993/ajhb.36.5.4.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To use the theory of planned behavior to identify predictors of intentions to use cessation aids when quitting smoking. METHODS African American smokers completed a survey to assess intentions, attitudes, and normative and control beliefs regarding the use of smoking cessation aids. RESULTS Participants held mildly positive attitudes regarding the use of cessation aids. Beliefs related to the utility of aids, support of referents, and accessibility of a doctor were most strongly associated with intention to use cessation aids. CONCLUSIONS African American smokers may be amenable to the use of cessation aids, and specific beliefs may be targets for intervention.
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Affiliation(s)
- Ian Lynam
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA.
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712
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Etter JF, Schneider NG. An internet survey of use, opinions and preferences for smoking cessation medications: nicotine, varenicline, and bupropion. Nicotine Tob Res 2012; 15:59-68. [PMID: 22529220 DOI: 10.1093/ntr/nts084] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We assessed use, compliance and preferences among smoking cessation medications in a "real world" sample of current and former smokers. METHODS Internet survey on a smoking cessation website (French/English, 2008-2010) to assess use of nicotine replacement therapies (NRT), varenicline, and bupropion. RESULTS There were 885 participants (39% current smokers, 61% former smokers), the majority of the sample (70%) was female. The most frequently used medications were, in order: patches (40%), varenicline (23%), nicotine gum (16%), nicotine lozenge/tablet (10%), bupropion (8%), and inhaler (3%). Satisfaction, perceived relief of craving/withdrawal and effectiveness were best for varenicline and lowest for gum. In current users, duration of use was longest for gum (121 days), lozenge/tablet (152 days) and shortest for patch (25 days). Daily use was good for lozenge (9 pieces/day) but less than recommended for gum (6 pieces/day) and inhaler (2 plugs/day). People who tried more than 1 medication found varenicline more effective and satisfactory than NRT or bupropion; and users preferred patch to gum. By smoking status, former smokers had more education, reported greater use of medications (daily, over time) and reported more satisfaction with medications than current smokers. CONCLUSIONS An Internet survey showed smoking cessation medications differed significantly in perceived effectiveness, satisfaction, and smoking status (former vs. current smoking). Except for lozenge/tablet, insufficient daily use remained a problem with acute NRTs. For all medications, improving outcome may require better instruction for proper use, approval of new indications (precessation) or development of new medications that bypass compliance issues that undermine success.
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Affiliation(s)
- Jean-François Etter
- Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva, Switzerland.
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713
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McKirnan DJ, Du Bois SN, Alvy LM, Jones K. Health Care Access and Health Behaviors Among Men Who Have Sex With Men. HEALTH EDUCATION & BEHAVIOR 2012; 40:32-41. [DOI: 10.1177/1090198111436340] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Men who have sex with men (MSM) appear to experience barriers to health care compared with general population men. This report examines individual differences in health care access within a diverse sample of urban MSM ( N = 871). The authors examined demographic differences in health care access and the relation between access and health-related attitudes, health behaviors, and HIV transmission risk. They operationalized health care access in terms of three indicators: perceived barriers, insurance status, and recent medical visit. Twenty-seven percent ( n = 227) of MSM reported zero or one health care access indicator. African American and Latino race/ethnicity, lower income, and HIV-unknown status were associated with limited health care access. Limited health care access was related to health care attitudes (mistrust in the health care system and difficulty disclosing MSM status to providers), general health behaviors (smoking, never being HIV-tested, and drug abuse), and sexual risk–related variables (low self-efficacy for sexual safety, consistent drug use during sex, and HIV transmission risk). Overall, among MSM, less health care access relates to several adverse psychological constructs and health behaviors. Researchers and public health officials should address limited health care access, and its consequences, in this population.
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Affiliation(s)
- David J. McKirnan
- The University of Illinois at Chicago, Chicago, IL, USA
- Howard Brown Health Center, Chicago, IL, USA
| | - Steve N. Du Bois
- The University of Illinois at Chicago, Chicago, IL, USA
- Howard Brown Health Center, Chicago, IL, USA
| | - Lisa M. Alvy
- The University of Illinois at Chicago, Chicago, IL, USA
- Howard Brown Health Center, Chicago, IL, USA
| | - Kyle Jones
- The University of Illinois at Chicago, Chicago, IL, USA
- Howard Brown Health Center, Chicago, IL, USA
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714
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Filion KB, Steffen LM, Duval S, Jacobs DR, Blackburn H, Luepker RV. Trends in smoking among adults from 1980 to 2009: the Minnesota heart survey. Am J Public Health 2012; 102:705-13. [PMID: 21852651 PMCID: PMC3489364 DOI: 10.2105/ajph.2011.300162] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined population-based smoking trends in Minnesota between 1980 and 2009. METHODS The Minnesota Heart Survey (MHS) is a population-based, serial, cross-sectional study of cardiovascular risk factor trends among Minneapolis-Saint Paul metropolitan residents. The MHS recently completed its sixth survey (1980-1982 [n = 3799], 1985-1987 [n = 4641], 1990-1992 [n = 5159], 1995-1997 [n = 6690], 2000-2002 [n = 3281], and 2007-2009 [n = 3179]). We used MHS data to examine smoking trends among adults aged 25 to 74 years by means of age-adjusted generalized linear mixed models. RESULTS Between 1980 and 2009, the prevalence of current smoking decreased from 32.8% to 15.5% for men and from 32.7% to 12.2% for women (P < .001 for each). Greater decreases occurred among those with higher income and those with more education. Among currently smoking men, the number of cigarettes smoked per day decreased from 26.0 in the 1980-1982 survey to 16.0 in the 2007-2009 survey (P < .001). Similar trends were observed among women. CONCLUSIONS Although the prevalence of smoking and cigarette consumption decreased from the 1980-1982 period to the 2007-2009 period, interventions specifically designed for those of lower socioeconomic status are needed.
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Affiliation(s)
- Kristian B Filion
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis 55454, USA
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715
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Oztürk O, Yılmazer I, Akkaya A. The attitudes of surgeons concerning preoperative smoking cessation: a questionnaire study*. Hippokratia 2012; 16:124-129. [PMID: 23935267 PMCID: PMC3738413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the attitudes and behavior of surgeons regarding preoperative smoking cessation. METHODS A total of 109 anonymous questionnaires were distributed to non-vascular surgeons in our hospital, inquiring about their smoking attitudes, their smoking cessation advice practices, whether they appreciated the benefits of preoperative smoking cessation, and their knowledge of smoking cessation methods. RESULTS Eighty questionnaires (from 51 resident doctors and 29 academic staff) were returned (response rate: 73.40%). Of the surgeons, 17.50% were current smokers. Although 40% of the surgeons surveyed believed that preoperative smoking cessation reduces postoperative complications, 31.2% of the surgeons (25/63) had given smoking cessation advice at least to 1 patient in the last month. Most of the resident doctors (39.2%) advised smoking cessation within a month; prior to surgery however, the academic staff (27.6%) advised cessation immediately before the operation (p=0.038). There was a significant difference between academic sfaff and resident doctors concerning the method to increase a patient's chance of quitting (p=0.045), even among current smokers (p=0.049). CONCLUSION The surgeons who participated in the questionnaire were aware that smoking cessation improves outcome, but most of them did not appreciate that providing brief advice, referring to cessation services, or prescribing nicotine replacement therapy (NRT) may be of benefit in helping patients to quit. It is necessary to educate surgeons about the scale of the benefit and the efficacy of smoking cessation interventions or to set up systematic frameworks to offer smoking cessation advice to preoperative patients who smoke.
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Affiliation(s)
- O Oztürk
- Department of Chest Diseases, Faculty of Medicine, University of Süleyman Demirel, Isparta, Turkey
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716
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Simmons VN, Litvin EB, Unrod M, Brandon TH. Oncology healthcare providers' implementation of the 5A's model of brief intervention for smoking cessation: patients' perceptions. PATIENT EDUCATION AND COUNSELING 2012; 86:414-9. [PMID: 21784598 PMCID: PMC3222746 DOI: 10.1016/j.pec.2011.06.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 05/20/2011] [Accepted: 06/23/2011] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Health care providers (HCPs) can play an important role in promoting smoking cessation and preventing relapse. Public Health Service guidelines recommend the "5A's" model of brief intervention. The goal of the current study was to examine cancer patients' perceptions of 5A's model implementation by their oncology HCPs. METHODS This study included 81 thoracic and 87 head and neck cancer patients at a large NCI-designated comprehensive cancer center. Patients completed questionnaires assessing perceptions of their oncology HCPs' implementation of the 5A's model of brief intervention. RESULTS Results indicate partial implementation of the 5A's model. The majority of patients reported that their providers had asked about smoking and advised them to quit, however; only half reported that their interest in quitting had been assessed, and few reported assistance in quitting or follow-up. Delivery of the 5A's was greater among patients who requested cessation advice from their HCPs. CONCLUSION The current findings suggest a need to increase adherence to the 5A's in the oncology setting. PRACTICAL IMPLICATIONS Efforts to increase smoking cessation treatment provision by HCPs may improve the rate of cessation among cancer patients, and ultimately translate into better long-term cancer treatment outcomes.
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Affiliation(s)
- Vani Nath Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33647, USA.
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717
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Abstract
BACKGROUND More remains unknown than known about how to optimize multiple health behaviour change. METHODS After reviewing the prevalence and comorbidities among major chronic disease risk behaviours for adults and youth, we consider the origins and applicability of high-risk and population strategies to foster multiple health behaviour change. RESULTS Findings indicate that health risk behaviours are prevalent, increase with age and co-occur as risk behaviour clusters or bundles. CONCLUSIONS We conclude that both population and high-risk strategies for health behaviour intervention are warranted, potentially synergistic and need intervention design that accounts for substitute and complementary relationships among bundled health behaviours. To maximize positive public health impact, a pressing need exists for bodies of basic and translational science that explain health behaviour bundling. Also needed is applied science that elucidates the following: (1) the optimal number of behaviours to intervene upon; (2) how target behaviours are best selected (e.g. greatest health impact; patient preference or positive effect on bundled behaviours); (3) whether to increase healthy or decrease unhealthy behaviours; (4) whether to intervene on health behaviours simultaneously or sequentially and (5) how to achieve positive synergies across individual-, group- and population-level intervention approaches.
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Affiliation(s)
- Bonnie Spring
- Department of Preventive Medicine, Northwestern University, 680 North Lakeshore Drive, Suite 1220, Chicago, IL 60611, USA.
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718
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Okwuosa TEM, Williams KA. Cardiovascular Health in Africans Living in the United States. CURRENT CARDIOVASCULAR RISK REPORTS 2012. [DOI: 10.1007/s12170-012-0227-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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719
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720
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Long-term efficacy and safety of varenicline for smoking cessation: a systematic review and meta-analysis of randomized controlled trials. J Public Health (Oxf) 2012. [DOI: 10.1007/s10389-011-0476-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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721
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Moore RA, Aubin HJ. Do placebo response rates from cessation trials inform on strength of addictions? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:192-211. [PMID: 22470287 PMCID: PMC3315081 DOI: 10.3390/ijerph9010192] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 01/06/2012] [Accepted: 01/06/2012] [Indexed: 01/08/2023]
Abstract
There is an implied assumption that addictions to different substances vary in strength from weak (easier to stop) to strong (harder to stop), though explicit definitions are lacking. Our hypothesis is that the strength of addictions can be measured by cessation rates found with placebo or no treatment controls, and that a weaker addiction would have a higher cessation rate than a stronger addiction. We report an overview of systematic reviews and meta-analyses of cessation trials, using randomised or quasi-randomised trials and reporting objectively-measured abstinence. The outcome for comparison was quit rates-typically the percentage of participants abstinent according to an objective test of abstinence at six months or longer. Twenty-eight cessation reviews (139,000 participants) were found. Most data came from reviews of smoking cessation in over 127,000 participants, and other reviews each covered a few thousand participants. Few reviews used data from studies shorter than three months, and almost all determined abstinence using objective measures. Cessation rates with placebo in randomised trials using objective measures of abstinence and typically over six months duration were 8% for nicotine, 18% for alcohol, 47% for cocaine, and 44% for opioids. Evidence from placebo cessation rates indicates that nicotine is more difficult to give up than alcohol, cocaine, and opioids. Tobacco is also a severe addiction, with a number of major deleterious health effects in a large number of people.
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Affiliation(s)
- Robert A. Moore
- Nuffield Division of Anaesthetics, University of Oxford, The Churchill, Oxford OX1 2JD, UK;
| | - Henri-Jean Aubin
- Hôpital Universitaire Paul Brousse, Université Paris-Sud, INSERM U699, 12 Avenue PV Couturier, BP 200, Villejuif Cedex 94804, France
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722
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Tamimi A, Serdarevic D, Hanania NA. The effects of cigarette smoke on airway inflammation in asthma and COPD: therapeutic implications. Respir Med 2011; 106:319-28. [PMID: 22196881 DOI: 10.1016/j.rmed.2011.11.003] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/01/2011] [Accepted: 11/02/2011] [Indexed: 12/29/2022]
Abstract
Asthma and COPD are two chronic inflammatory disorders of the airway characterized by airflow limitation. While many similarities exist between these two diseases, they are pathologically distinct due to the involvement of different inflammatory cells; predominantly neutrophils, CD8 lymphocytes in COPD and eosinophils and CD4 lymphocytes in asthma. Cigarette smoking is associated with accelerated decline of lung function, increased mortality, and worsening of symptoms in both asthma and COPD. Furthermore, exposure to cigarette smoke can alter the inflammatory mechanisms in asthma to become similar to that seen in COPD with increasing CD8 cells and neutrophils and may therefore alter the response to therapy. Cigarette smoke exposure has been associated with a poor response to inhaled corticosteroids which are recommended as first line anti-inflammatory medications in asthma and as an add-on therapy in patients with severe COPD with history of exacerbations. While the main proposed mechanism for this altered response is the reduction of the histone deacetylase 2 (HDAC2) enzyme system, other possible mechanisms include the overexpression of GR-β, activation of p38 MAPK pathway and increased production of inflammatory cytokines such as IL-2, 4, 8, TNF-α and NF-Kß. Few clinical trials suggest that leukotriene modifiers may be an alternative to corticosteroids in smokers with asthma but there are currently no drugs which effectively reduce the progression of inflammation in smokers with COPD. However, several HDAC2 enhancers including low dose theophylline and other potential anti-inflammatory therapies including PDE4 inhibitors and p38 MAPK inhibitors are being evaluated.
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Affiliation(s)
- Asad Tamimi
- Clinical Sciences, Primary Care Business Unit, Pfizer Inc, Ramsgate Road, Sandwich CT13 9NJ, UK
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723
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Associations Between Preconception Counseling and Maternal Behaviors Before and During Pregnancy. Matern Child Health J 2011; 16:1854-61. [DOI: 10.1007/s10995-011-0932-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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724
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Hurt RD, Ebbert JO, Hays JT, McFadden DD. Preventing Lung Cancer by Treating Tobacco Dependence. Clin Chest Med 2011; 32:645-57. [DOI: 10.1016/j.ccm.2011.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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725
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Ahmady AE, Golmohammadi S, Ayremlou S, Khoshnevisan MH, Lando HA. Tobacco cessation practices of senior dental students in Iran. Int Dent J 2011; 61:302-6. [PMID: 22117786 DOI: 10.1111/j.1875-595x.2011.00066.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Tobacco use is prevalent in Iran, especially among men. The aim was to assess cessation practices and identify perceived barriers to delivery of tobacco cessation services by Iranian senior dental students. DESIGN Descriptive, cross-sectional study. SETTING Iran, Schools of Dentistry, 2009-2010. PARTICIPANTS 370 (response rate 82%) officially registered senior dental students selected through stratified random sampling. INTERVENTION Students at 11 dental schools throughout the country completed the survey. MAIN OUTCOME MEASURE Students' practice of the US Clinical Practice Guideline 5 As (ask, advise, assess, assist, arrange); interest in training; intention and barriers addressing tobacco use in dental settings. RESULTS AND CONCLUSIONS Respondents were primarily female (67.8%). The students were far more likely to be actively involved in asking, advising and assessing patients to quit than in assisting and arranging. Most respondents (68.5%) agreed that it is within the scope of dental practice to help smokers quit. The most important barriers to providing cessation services included perceived patient resistance (44%) and lack of a supportive organisation (36%). This was the first assessment of approaches to tobacco users by dental students in Iran. Although there clearly is room for improvement, the interest of the students toward tobacco cessation is encouraging.
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Affiliation(s)
- Arezoo Ebn Ahmady
- Dental Research Center and Dental School, Shahid Behshti University of Medical Sciences, Daneshjo BLVD, Evin Square, Tehran, Iran
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726
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Etter JF. Comparing abrupt and gradual smoking cessation: a randomized trial. Drug Alcohol Depend 2011; 118:360-5. [PMID: 21571448 DOI: 10.1016/j.drugalcdep.2011.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 04/19/2011] [Accepted: 04/19/2011] [Indexed: 11/19/2022]
Abstract
AIMS To compare abrupt and gradual smoking cessation. DESIGN AND SETTING Randomized trial and observational study, Internet, 2007-2010. PARTICIPANTS Smokers with no strong preference for abrupt or gradual quitting were randomly assigned to quitting immediately (n=472), or to gradually reducing their cigarette consumption over 2 weeks and then quit (n=502). Smokers who strongly preferred to quit abruptly were instructed to do so immediately (n=2456), those who strongly preferred gradual were instructed to reduce their cigarette consumption over 2 weeks, then quit (n=1801). Follow-up was conducted 4 weeks after target quit dates. FINDINGS Those who preferred abrupt quitting were the most motivated to quit and the most confident in their ability to quit. At follow-up, quit rates were 16% in those who preferred abrupt cessation, 7% in those who preferred gradual cessation and 9% in those who had no preference (p<0.001). In the latter group, quit rates were equal for those randomized to abrupt or gradual (9%, p=0.97). In those who expressed a strong preference for either method, there were interactions between quitting method, motivation to quit and confidence in ability to quit: those who had low levels of motivation or low levels of confidence were more likely to quit at follow-up if they preferred and used abrupt rather than gradual. CONCLUSIONS In those who had no strong preference for either method, abrupt and gradual produced similar results. Those who preferred and used the abrupt method were more likely to quit than those who preferred and used the gradual method, in particular when they had low motivation and confidence.
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Affiliation(s)
- Jean-François Etter
- Institute of Social and Preventive Medicine, University of Geneva, CMU, case postale, CH-1211 Geneva 4, Switzerland.
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727
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Asfar T, Al-Ali R, Ward KD, Vander Weg MW, Maziak W. Are primary health care providers prepared to implement an anti-smoking program in Syria? PATIENT EDUCATION AND COUNSELING 2011; 85:201-205. [PMID: 21168300 PMCID: PMC3074023 DOI: 10.1016/j.pec.2010.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 10/15/2010] [Accepted: 11/21/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To document primary health care (PHC) providers' tobacco use, and how this influences their smoking cessation practices and attitudes towards tobacco-control policies. METHODS Anonymous questionnaires were distributed to PHC providers in 7 randomly selected PHC centers in Aleppo, Syria. RESULTS All PHC providers completed the questionnaires (100% response rate). A quarter of these providers smoke cigarettes and more than 10% smoke waterpipes. Physicians who smoke were less likely to advise patients to quit (OR=0.29; 95% CI, 0.09-0.95), assess their motivation to quit (OR=0.13, 95% CI=0.02-0.72), or assist them in quitting (OR=0.24, 95% CI=0.06-0.99). PHC providers who smoke were less likely to support a ban on smoking in PHC settings (68.2% vs. 89.1%) and in enclosed public places (68.2% vs. 86.1%) or increases in the price of tobacco products (43.2% vs. 77.4%) (P<0.01 for all comparisons). CONCLUSIONS Smoking, including waterpipe, continues to be widespread among PHC providers in Syria and will negatively influence implementation of anti-smoking program in PHC settings. PRACTICE IMPLICATIONS Smoking awareness and cessation interventions targeted to PHC providers, and training programs to build providers' competency in addressing their patients' smoking is crucial in Syria.
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Affiliation(s)
- Taghrid Asfar
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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728
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Graham AL, Papandonatos GD, Kang H, Moreno JL, Abrams DB. Development and validation of the online social support for smokers scale. J Med Internet Res 2011; 13:e69. [PMID: 21955465 PMCID: PMC3222172 DOI: 10.2196/jmir.1801] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 05/10/2011] [Accepted: 05/11/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social networks play an important role in smoking. Provision of social support during cessation is a cornerstone of treatment. Online social networks for cessation are ubiquitous and represent a promising modality for smokers to receive and provide the support necessary for cessation. There are no existing measures specific to online social support for smoking cessation. OBJECTIVE The objective was to develop a measure of social support to be used in online smoking cessation treatment research. METHODS Initial items for the Online Social Support for Smokers Scale (OS4) were based on existing theory and scales delineated in various taxonomies. Preliminary field analysis (N = 73) was conducted on 23 initial items to optimize the scale. Further development was conducted on a refined 15-item scale in the context of a large randomized trial of Internet and telephone cessation treatment with follow-ups at 3, 6, 12, and 18 months. In all, 1326 participants were randomized to an enhanced Internet arm that included a large online social network; psychometric analyses employed 3-month follow-up data from those reporting use of the enhanced Internet intervention at least once (n = 873). Items were subjected to a factor analysis, and the internal consistency reliability of the scale was examined along with construct and criterion validity. Other measures used in the study included demographics, nicotine dependence, partner support for cessation, general social support, social integration, stress, depression, health status, online community use, Internet use behaviors, intervention satisfaction, and 30-day point prevalence abstinence. RESULTS The final 12-item OS4 scale demonstrated high internal consistency reliability (Cronbach alphas .86-.89) across demographic and smoking strata of interest. The OS4 also demonstrated good construct and criterion validity, with the directionality of the observed associations providing support for most a priori hypotheses. Significant Pearson correlations were observed between the OS4 and the Partner Interaction Questionnaire (PIQ) Positive subscale (ρ = .24, P < .001). As hypothesized, participants with the highest OS4 scores were more likely to have actively participated in the enhanced Internet community and to have high levels of satisfaction with the enhanced Internet intervention. In logistic regression analyses, the OS4 was highly predictive of 30-day point-prevalence abstinence at 6, 12, and 18 months (all P values <.001). The odds of abstinence at 6 months rose by 48% for each standard unit increase in online social support (95% confidence interval [CI] 1.17-1.71), dropping only slightly to 37% at 12 and 18 months (95% CI 1.17-1.59). CONCLUSIONS The OS4 is a brief, reliable, and valid instrument for measuring online social support for smoking cessation. Results should be replicated and extended, but this study suggests the OS4 can be used to advance theory, understand mechanisms, and potentially help to improve the tailoring of Internet-based smoking cessation treatments. It can also inspire development of similar measures for other online health-related intervention research. TRIAL REGISTRATION Clinicaltrials.gov #NCT00282009; http://clinicaltrials.gov/ct2/show/NCT00282009 (Archived by WebCite at http://www.webcitation.org/60XNj3xM6).
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, Washington, DC, USA.
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729
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Gray KM, Riggs PD, Min SJ, Mikulich-Gilbertson SK, Bandyopadhyay D, Winhusen T. Cigarette and cannabis use trajectories among adolescents in treatment for attention-deficit/hyperactivity disorder and substance use disorders. Drug Alcohol Depend 2011; 117:242-7. [PMID: 21411243 PMCID: PMC3128687 DOI: 10.1016/j.drugalcdep.2011.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/10/2011] [Accepted: 02/10/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cigarette smoking is common in adolescents with attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, little is known about the relationship between cigarette and cannabis use trajectories in the context of treatment for both ADHD and SUD. To address this research gap, we report collateral analyses from a 16-week randomized, controlled trial (n=303) of osmotic-release methylphenidate (OROS-MPH) in adolescents with ADHD concurrently receiving cognitive behavioral therapy (CBT) targeting non-nicotine SUD. METHODS Participants completed cigarette and cannabis use self-report at baseline and throughout treatment. Analyses were performed to explore the relationships between cigarette smoking, cannabis use, and other factors, such as medication treatment assignment (OROS-MPH versus placebo). RESULTS Baseline (pre-treatment) cigarette smoking was positively correlated with cannabis use. Negligible decline in cigarette smoking during treatment for non-nicotine SUD was observed in both medication groups. Regular cigarette and cannabis users at baseline who reduced their cannabis use by >50% also reduced cigarette smoking (from 10.8±1.1 to 6.2±1.1 cigarettes per day). CONCLUSIONS Findings highlight the challenging nature of concurrent cannabis and cigarette use in adolescents with ADHD, but demonstrate that changes in use of these substances during treatment may occur in parallel.
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Affiliation(s)
- Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC861, Charleston, SC 29425, USA.
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730
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The Receipt and Utilization of Effective Clinical Smoking Cessation Services in Subgroups of the Insured and Uninsured Populations in the USA. J Behav Health Serv Res 2011; 39:202-13. [DOI: 10.1007/s11414-011-9255-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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731
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Carlsten C, Halperin A, Crouch J, Burke W. Personalized medicine and tobacco-related health disparities: is there a role for genetics? Ann Fam Med 2011; 9:366-71. [PMID: 21747109 PMCID: PMC3133585 DOI: 10.1370/afm.1244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Genetic testing has been proposed as a means to increase smoking cessation rates and thus reduce smoking prevalence. To understand how that might be practically possible, with appreciation of the current social context of tobacco use and dependence, we performed a contextual analysis of smoking-related genetics and smoking cessation. To provide added value, genetics would need to inform and improve existing interventions for smokers (including behavioral and pharmacological treatments). Pharmacogenetics offers the most promising potential, because it may improve the efficacy of medication-based smoking cessations strategies. All proven interventions for treating tobacco dependence, however, including simple cost-effective measures, such as quit lines and physician counseling, are underutilized. As tobacco use occurs disproportionately among disadvantaged populations, efforts to improve smokers' access to health care, and to the tools that are known to help them quit, represent the most promising approaches for reducing smoking prevalence within these groups. Similar considerations apply to other chronic diseases contributing to population-level health disparities. We conclude that although genetics offers increasing opportunities to tailor drug treatment, and may in some cases provide useful risk prediction, other methods of personalizing care are likely to yield greater benefit to populations experiencing health disparities related to tobacco use.
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732
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Bruner K, Chand D, Patel H, Stolfi A, Omoloja A. Chronic kidney disease, pediatric nephrologists, and tobacco counseling: perceptions and practice patterns. A study from the Midwest Pediatric Nephrology Consortium. J Pediatr 2011; 159:155-157.e1. [PMID: 21592511 DOI: 10.1016/j.jpeds.2011.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 03/08/2011] [Accepted: 03/21/2011] [Indexed: 11/19/2022]
Abstract
We sought to identify practice patterns of pediatric nephrologists for tobacco counseling, because of a high incidence of secondhand smoke exposure and tobacco use in adolescents with chronic kidney disease. Counseling was minimal for several reasons, thus increasing the risk for heart disease inherent in children with chronic kidney disease.
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Affiliation(s)
- Karen Bruner
- Department of Pediatrics, Wright-Patterson Air Force Base, Dayton, OH, USA
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733
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Robinson W, Moody-Thomas S, Gruber D. Patient perspectives on tobacco cessation services for persons living with HIV/AIDS. AIDS Care 2011; 24:71-6. [PMID: 22250886 DOI: 10.1080/09540121.2011.582078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
With the advent of highly active antiretroviral therapy, the survival for HIV-infected individuals has increased, but other health-related behaviors have been largely unaddressed. Tobacco use is of primary concern, given its prevalence and the medical implications of smoking among these patients. Improving responsiveness to the needs, values, and preferences of patients (i.e., patient-centeredness) is a focus for increasing participation in systems of care. To assess the social, cultural, and educational barriers limiting use of smoking cessation services by HIV-positive individuals, two focus groups were conducted at a Louisiana HIV outpatient clinic. Questions addressed smoking history, knowledge of and access to cessation services, and knowledge of effects of smoking on disease progression and medication efficacy. Identified themes included a desire for increased and more specific information on the health effects of smoking as related to the patients' HIV status, difficulty in quitting, motivation, and the increased burden of medication. These results provide recommendations for designing, for HIV-infected smokers, patient-centered treatment of tobacco use, including providing relevant knowledge, access to cessation services, and more effective messages related to the impact of tobacco use on disease progression.
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Affiliation(s)
- William Robinson
- LSU Health Sciences Center, School of Public Health, New Orleans, LA, USA
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734
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Oujiri J, Hakeem A, Pack Q, Holland R, Meyers D, Hildebrand C, Bridges A, Roach MA, Vogelman B. Resident-initiated interventions to improve inpatient heart-failure management. BMJ Qual Saf 2011; 20:181-6. [PMID: 21303773 DOI: 10.1136/bmjqs.2009.039339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Third-year internal medicine residents participating in a quality improvement rotation identified gaps between the Joint Commission's ORYX quality guidelines and clinical practices for the inpatient management of heart failure (HF) at the William S. Middleton Memorial Veterans Hospital. Residents focused on the performance metrics associated with tobacco-cessation counselling documentation, ejection fraction assessment and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescriptions. METHODS After analysing data collected by the External Peer Review Program, residents reviewed the institution's admissions and discharge processes with the aim of improving quality and compliance. In redesigning these processes, residents created an admissions template and a discharge face sheet, and compared specific ORYX measure compliance rates before and after institution-wide implementation. RESULTS Following implementation of the tobacco-cessation admissions template, 100% of HF patients who used tobacco received documented cessation counselling, compared with 59% prior to intervention (p<0.01, n=32). Following implementation of the mandatory discharge face sheet, 97% of HF patients (compared with 92% preintervention, p>0.05) received comprehensive discharge instruction; LV function assessment went from 98% to 100% (p>0.05); and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescription for left ventricular systolic dysfunction at discharge (or documentation of a contra-indication) went from 82% to 100% (p<0.01, n=48). DISCUSSION By implementing a standardised admissions template and a mandatory discharge face sheet, the hospital improved its processes of documentation and increased adherence to quality-performance measures. By strengthening residents' learning and commitment to quality improvement, the hospital created a foundation for future changes in the systems that affect patient care.
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Affiliation(s)
- James Oujiri
- William S Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
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735
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Dhippayom T, Chaiyakunapruk N, Jongchansittho T. Safety of nortriptyline at equivalent therapeutic doses for smoking cessation: a systematic review and meta-analysis. Drug Saf 2011; 34:199-210. [PMID: 21332244 DOI: 10.2165/11585950-000000000-00000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The limited use of nortriptyline for smoking cessation is likely due to concerns about its serious adverse effects. OBJECTIVE To examine the safety of nortriptyline at doses equivalent to those used in aiding smoking cessation. DATA SOURCES A systematic search of relevant articles in MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, CINAHL, PsychINFO, WHO publications and the Clinical Trials database (through November 2008). STUDY SELECTION All studies of nortriptyline at doses between 75 and 100 mg in any indication were reviewed. DATA EXTRACTION The quality of included studies was assessed based on the Jadad score. Data were extracted using a data extraction form. DATA SYNTHESIS From 442 potentially relevant articles identified, 17 studies met our selection criteria and were included for data analysis. Indications for nortriptyline in these studies were smoking cessation (eight studies), depression (five studies), neuropathic pain (three studies) and schizophrenia (one study). 2885 individuals participated in these studies, with exposure time ranging between 4 and 12 weeks. The major comparator used in these trials was placebo. Overall, no life-threatening events occurred in these studies. Orthostatic hypotension was significantly higher in nortriptyline users than in comparator groups (relative risk 2.8; 95% CI 1.4, 5.3). Other adverse events significantly associated with nortriptyline were anticholinergic-related effects including drowsiness, dizziness, gastrointestinal disturbance and dysgeusia. CONCLUSIONS Current evidence suggests that nortriptyline, at doses between 75 and 100 mg, is not significantly associated with serious adverse events when administered in patients without underlying cardiovascular disease.
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Affiliation(s)
- Teerapon Dhippayom
- Pharmaceutical Care Research Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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736
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Medbø A, Melbye H, Rudebeck CE. "I did not intend to stop. I just could not stand cigarettes any more." A qualitative interview study of smoking cessation among the elderly. BMC FAMILY PRACTICE 2011; 12:42. [PMID: 21627833 PMCID: PMC3132720 DOI: 10.1186/1471-2296-12-42] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 05/31/2011] [Indexed: 11/16/2022]
Abstract
Background Every year, more than 650,000 Europeans die because they smoke. Smoking is considered to be the single most preventable factor influencing health. General practitioners (GP) are encouraged to advise on smoking cessation at all suitable consultations. Unsolicited advice from GPs results in one of 40-60 smokers stopping smoking. Smoking cessation advice has traditionally been given on an individual basis. Our aim was to gain insights that may help general practitioners understand why people smoke, and why smokers stop and then remain quitting and, from this, to find fruitful approaches to the dialogue about stopping smoking. Methods Interviews with 18 elderly smokers and ex-smokers about their smoking and decisions to smoke or quit were analysed with qualitative content analysis across narratives. A narrative perspective was applied. Results Six stages in the smoking story emerged, from the start of smoking, where friends had a huge influence, until maintenance of the possible cessation. The informants were influenced by "all the others" at all stages. Spouses had vital influence in stopping, relapses and continued smoking. The majority of quitters had stopped by themselves without medication, and had kept the tobacco handy for 3-6 months. Often smoking cessation seemed to happen unplanned, though sometimes it was planned. With an increasingly negative social attitude towards smoking, the informants became more aware of the risks of smoking. Conclusion "All the others" is a clue in the smoking story. For smoking cessation, it is essential to be aware of the influence of friends and family members, especially a spouse. People may stop smoking unplanned, even when motivation is not obvious. Information from the community and from doctors on the negative aspects of smoking should continue. Eliciting life-long smoking narratives may open up for a fruitful dialogue, as well as prompting reflection about smoking and adding to the motivation to stop.
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Affiliation(s)
- Astri Medbø
- Institute of Community Medicine, University of Tromsø, 9037 Tromsø, Norway.
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737
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Abstract
Coronary heart disease (CHD) is the leading cause of mortality in the industrialized world and that might also soon be the case in other parts of the world. There are several easily measured and potentially modifiable risk factors that account for a substantial proportion of the risk of CHD. The effect of risk factors interventions appears to be consistent in both genders, across different geographic regions, and by all ethnic groups, suggesting that approaches to prevention can be based on similar principles worldwide. Optimal target levels for serum cholesterol and blood pressure are not yet clear. Future risk CHD reduction will mainly be achieved by improved primary prevention.
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Affiliation(s)
- Stefan Agewall
- Department of Medicine, Oslo University Hospital Ullevål and Oslo University, 0407 Oslo, Norway
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738
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Kotz D, Fidler JA, West R. Did the introduction of varenicline in England substitute for or add to the use of other smoking cessation medications? Nicotine Tob Res 2011; 13:793-9. [PMID: 21543548 DOI: 10.1093/ntr/ntr075] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Varenicline has recently been added to the market as a new drug for smoking cessation. The aim of the current study was to assess whether varenicline substituted for, or added to, the use of other smoking cessation medications. METHODS We used data from 2,595 smokers taking part in monthly household surveys of representative samples of the English population. We analyzed the percentage of smokers attempting to quit in the past 3 months and using nicotine replacement therapy over the counter (NRT OTC), NRT on prescription (NRT Rx), bupropion, or varenicline from November 2006 to December 2009. This survey covered 3 periods: (a) after the launch of varenicline but before the publication of the National Institute of Health and Clinical Excellence guidance on varenicline in July 2007, (b) the first year following the guidance, and (c) more than 1 year after the guidance. RESULTS Varenicline usage was negligible in the first period, increased steadily during the second period, and increased less rapidly in the third period to 5.3% of those making a quit attempt (p < .001 for the trend). The percentage of quit attempters using any smoking cessation medication increased nonsignificantly by 2.8 percentage points from 41.7% to 44.5% (p = .268). The use of NRT OTC decreased significantly by 6.2 percentage points from 35.2% to 29.0% (p = .029), whereas the use of NRT Rx increased significantly by 3.7 percentage points from 6.8% to 10.5% (p = .025), and use of bupropion remained unchanged. CONCLUSIONS Increased use of varenicline in England following guidance from the National Institute for Clinical Excellence in 2007 did not appear to substitute for use of other prescription smoking cessation medication. An observed decline in NRT OTC is likely to have been due to other factors.
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Affiliation(s)
- Daniel Kotz
- Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands.
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739
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Daley CM, Faseru B, Nazir N, Solomon C, Greiner KA, Ahluwalia JS, Choi WS. Influence of traditional tobacco use on smoking cessation among American Indians. Addiction 2011; 106:1003-9. [PMID: 21306597 PMCID: PMC3074043 DOI: 10.1111/j.1360-0443.2011.03391.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To examine the influence of traditional tobacco use on smoking cessation among American Indian adult smokers. DESIGN, SETTING AND PARTICIPANTS A cross-sectional survey of self-identified American Indians was conducted from 2008 to 2009. A total of 998 American Indian adults (18 years and older) from the Midwest participated in the study. MEASUREMENTS Traditional tobacco use and method of traditional use were both assessed. Commercial tobacco use (current smoking) was obtained through self-reported information as well as the length of their most recent quit attempt. We also assessed knowledge and awareness of pharmacotherapy for current smokers. FINDINGS Among participants in our study, 33.3% were current smokers and they reported smoking an average of 10 cigarettes per day. American Indian current smokers who used traditional tobacco reported a greater number of days abstinent during their last quit attempt compared to those who do not use traditional tobacco (P = 0.01). However, it appears that this protective effect of traditional tobacco use is diminished if the person smokes traditional tobacco. Finally, very few (fewer than 20% of current smokers) were aware of more recent forms of pharmacotherapy such as Chantix or bupropion. CONCLUSIONS American Indians appear to show low levels of awareness of effective pharmacotherapies to aid smoking cessation, but those who use 'traditional tobacco' report somewhat longer periods of abstinence from past quit attempts.
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Affiliation(s)
- Christine M. Daley
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Babalola Faseru
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | | | - K. Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
| | | | - Won S. Choi
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
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740
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Okoli CT, Torchalla I, Oliffe JL, Bottorff JL. Men's smoking cessation interventions: a brief review. JOURNAL OF MENS HEALTH 2011. [DOI: 10.1016/j.jomh.2011.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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741
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Lough LE, Ebbert JO, McLeod TG. Evaluation of a student-run smoking cessation clinic for a medically underserved population. BMC Res Notes 2011; 4:55. [PMID: 21385457 PMCID: PMC3065429 DOI: 10.1186/1756-0500-4-55] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 03/08/2011] [Indexed: 11/10/2022] Open
Abstract
Background Smoking is common among medically underserved populations. Accessible resources to encourage and support smoking cessation among these patients are limited. Volunteer medical student-run free smoking cessation clinics may provide an effective option to help these individuals achieve smoking abstinence. In order to demonstrate the feasibility and cost-effectiveness of a student-run clinic, we analyzed a case series of patients receiving care in a medical student-run Smoking Cessation Clinic (SCC) at the Rochester, Minnesota Salvation Army Good Samaritan Health Clinic (GSHC). Findings Between January 2005 and March 2009, 282 cigarette smokers seeking care at the SCC were analyzed. Student providers at the SCC conducted 1652 weekly individual counseling sessions averaging 18 minutes per encounter. Patients were offered a choice of pharmacotherapies including nicotine replacement therapy (NRT), bupropion, and varenicline for up to 12 weeks. Smoking abstinence was confirmed with exhaled carbon monoxide (CO). Thirty-two patients completed the entire 12-week program (11.3%). At last contact, 94 patients (33.3%) abstained from smoking for ≥ 7 days and 39 patients (13.8%) were continuously abstinent for ≥ 4 weeks. The 7-day point prevalence abstinence rates at last contact were 58.6% for varenicline, 41.2% for bupropion, 33.9% for NRT, and 23.5% for bupropion and NRT. Analyzing missing patients as smoking, the 7-day point prevalence abstinence rates were 7.1%, 8.9%, and 8.2%, at 1 month, 2 months, and 3 months after program enrollment, respectively. No serious adverse drug reactions were recorded. Conclusions Our medical student-run smoking cessation clinic provided an effective and safe experience for medically underserved patients who might not otherwise have access to conventional smoking cessation programs because of high cost, lack of insurance, or other disparities. Similar medical student initiatives focusing on healthy lifestyles may be feasible and beneficial for individuals with limited access to healthcare resources.
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Affiliation(s)
- Lindsay E Lough
- Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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742
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Shi L, Tian H, McCarthy WJ, Berman B, Wu S, Boer R. Exploring the uncertainties of early detection results: model-based interpretation of mayo lung project. BMC Cancer 2011; 11:92. [PMID: 21375784 PMCID: PMC3058105 DOI: 10.1186/1471-2407-11-92] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 03/07/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Mayo Lung Project (MLP), a randomized controlled clinical trial of lung cancer screening conducted between 1971 and 1986 among male smokers aged 45 or above, demonstrated an increase in lung cancer survival since the time of diagnosis, but no reduction in lung cancer mortality. Whether this result necessarily indicates a lack of mortality benefit for screening remains controversial. A number of hypotheses have been proposed to explain the observed outcome, including over-diagnosis, screening sensitivity, and population heterogeneity (initial difference in lung cancer risks between the two trial arms). This study is intended to provide model-based testing for some of these important arguments. METHOD Using a micro-simulation model, the MISCAN-lung model, we explore the possible influence of screening sensitivity, systematic error, over-diagnosis and population heterogeneity. RESULTS Calibrating screening sensitivity, systematic error, or over-diagnosis does not noticeably improve the fit of the model, whereas calibrating population heterogeneity helps the model predict lung cancer incidence better. CONCLUSIONS Our conclusion is that the hypothesized imperfection in screening sensitivity, systematic error, and over-diagnosis do not in themselves explain the observed trial results. Model fit improvement achieved by accounting for population heterogeneity suggests a higher risk of cancer incidence in the intervention group as compared with the control group.
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Affiliation(s)
- Lu Shi
- Department of Health Services, 650 Charles E, Young Drive S, 61-253 CHS, Los Angeles, CA 90095, USA.
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743
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Abroms LC, Padmanabhan N, Thaweethai L, Phillips T. iPhone apps for smoking cessation: a content analysis. Am J Prev Med 2011; 40:279-85. [PMID: 21335258 PMCID: PMC3395318 DOI: 10.1016/j.amepre.2010.10.032] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 07/28/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND With the proliferation of smartphones such as the iPhone, mobile phones are being used in novel ways to promote smoking cessation. PURPOSE This study set out to examine the content of the 47 iPhone applications (apps) for smoking cessation that were distributed through the online iTunes store, as of June 24, 2009. METHODS Each app was independently coded by two reviewers for its (1) approach to smoking cessation and (2) adherence to the U.S. Public Health Service's 2008 Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Each app was also coded for its (3) frequency of downloads. RESULTS Apps identified for smoking cessation were found to have low levels of adherence to key guidelines in the index. Few, if any, apps recommended or linked the user to proven treatments such as pharmacotherapy, counseling, and/or a quitline. CONCLUSIONS iPhone apps for smoking cessation rarely adhere to established guidelines for smoking cessation. It is recommended that current apps be revised and future apps be developed around evidence-based practices for smoking cessation.
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Affiliation(s)
- Lorien C Abroms
- Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, 2175 K Street NW, Washington, DC 20037, USA.
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744
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Pipe AL, Eisenberg MJ, Gupta A, Reid RD, Suskin NG, Stone JA. Smoking Cessation and the Cardiovascular Specialist: Canadian Cardiovascular Society Position Paper. Can J Cardiol 2011; 27:132-7. [DOI: 10.1016/j.cjca.2010.12.060] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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745
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Bolam B, West R, Gunnell D. Does Smoking Cessation Cause Depression and Anxiety? Findings from the ATTEMPT Cohort. Nicotine Tob Res 2011; 13:209-14. [DOI: 10.1093/ntr/ntq244] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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746
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Matthews AK, Hotton A, DuBois S, Fingerhut D, Kuhns LM. Demographic, psychosocial, and contextual correlates of tobacco use in sexual minority women. Res Nurs Health 2011; 34:141-52. [DOI: 10.1002/nur.20427] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2011] [Indexed: 11/06/2022]
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747
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Smith PH, Homish GG, Barrick C, Grier NL. Using touch-screen technology to assess smoking in a low-income primary care clinic: a pilot study. Subst Use Misuse 2011; 46:1750-4. [PMID: 21974691 DOI: 10.3109/10826084.2011.618999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This pilot study examined the use of a touch-screen tablet personal computer to assess smoking and alcohol use among low-income primary care patients (N = 100) and tested cross-method consistency with a paper assessment. Data were collected in 2009. A touch-screen survey assessed smoking, alcohol use, partner smoking, and acceptability. A separate paper survey assessed smoking, partner smoking, and acceptability. The touch-screen assessment was highly acceptable and reliable. Implications and limitations are noted. Future research should explore the use of touch-screen technology for clinical endeavors requiring a quick assessment of substance use. There was no outside funding for this study.
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Affiliation(s)
- Philip H Smith
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York 14214, USA.
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748
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Papadakis S, Aitken D, Gocan S, Riley D, Laplante MA, Bhatnagar-Bost A, Cousineau D, Simpson D, Edjoc R, Pipe AL, Sharma M, Reid RD. A randomised controlled pilot study of standardised counselling and cost-free pharmacotherapy for smoking cessation among stroke and TIA patients. BMJ Open 2011; 1:e000366. [PMID: 22123923 PMCID: PMC3225588 DOI: 10.1136/bmjopen-2011-000366] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Tobacco use is a major risk factor for recurrent stroke. The provision of cost-free quit smoking medications has been shown to be efficacious in increasing smoking abstinence in the general population. Objective The objective of this pilot study was to assess the feasibility and obtain preliminary data on the effectiveness of providing cost-free quit smoking pharmacotherapy and counselling to smokers identified in a stroke prevention clinic. Trial design Cluster randomised controlled trial. Methods All patients seen at the Ottawa Hospital Stroke Prevention Clinic who smoked more five or more cigarettes per day, were ready to quit smoking in the next 30 days, and were willing to use pharmacotherapy were invited to participate in the study. All participants were advised to quit smoking and treated using a standardised protocol including counselling and pharmacotherapy. Participants were randomly assigned to either a prescription only usual care group or an experimental group who received a 4-week supply of cost-free quit smoking medications and a prescription for medication renewal. All patients received follow-up counselling. The primary outcome was biochemically validated quit rates at 26 weeks. The research coordinator conducting outcome assessment was blind to group allocation. Results Of 219 smokers screened, 73 were eligible, 28 consented and were randomised, and 25 completed the 26-week follow-up assessment. All 28 patients randomised were included in the analysis. The biochemically validated 7-day point prevalence abstinence rate in the experimental group compared to the usual care group was 26.6% vs 15.4% (adjusted OR 2.00, 95% CI 0.33 to 13.26; p=0.20). Conclusions It would be feasible to definitively evaluate this intervention in a large multi-site trial. Trial registration number http://ClinicalTrials.gov # UOHI2010-1.
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Affiliation(s)
- Sophia Papadakis
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Debbie Aitken
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sophia Gocan
- Champlain Regional Stroke Network, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Dana Riley
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mary Ann Laplante
- Champlain Regional Stroke Network, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Abha Bhatnagar-Bost
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Donna Cousineau
- Champlain Regional Stroke Network, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Danielle Simpson
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rojiemiahd Edjoc
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew L Pipe
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mukul Sharma
- Champlain Regional Stroke Network, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Robert D Reid
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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749
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Pisinger C, Aadahl M, Toft U, Jørgensen T. Motives to quit smoking and reasons to relapse differ by socioeconomic status. Prev Med 2011; 52:48-52. [PMID: 21047525 DOI: 10.1016/j.ypmed.2010.10.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 10/14/2010] [Accepted: 10/25/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate motives, strategies and experiences to quit smoking and reasons to relapse as a function of socioeconomic status. METHODS A population-based study, Inter99, Denmark. Two thousand six hundred twenty-one daily smokers with a previous quit attempt completed questionnaires at baseline. Cross-sectional baseline-data (1999-2001) were analysed in adjusted regression analyses. RESULTS Consistent findings across the three indicators of socioeconomic status (employment, school education, higher education/vocational training): smokers with low socioeconomic status were significantly more likely than smokers with high socioeconomic status to report that they wanted to quit because smoking was too expensive (OR: 1.85 (1.4-2.4), for school education) or because they had health related problems (OR: 1.75 (1.4-2.2)). When looking at previous quit attempts, smokers with low socioeconomic status were significantly more likely to report that it had been a bad experience (OR: 1.41 (1.1-1.8)) and that they had relapsed because they were more nervous/restless/depressed (OR: 1.43 (1.1-1.8)). CONCLUSIONS This study shows that smokers with low socioeconomic status have other motives to quit and other reasons to relapse than smokers with high socioeconomic status. Future tobacco prevention efforts aimed at smokers with low socioeconomic status should maybe focus on current advantages of quitting smoking, using high cost of smoking and health advantages of quitting as motivating factors and by including components of mental health as relapse prevention.
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Affiliation(s)
- Charlotta Pisinger
- Research Centre for Prevention and Health, The Capital Region of Denmark, Denmark.
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750
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Effectiveness of pharmacist counseling combined with nicotine replacement therapy: a pragmatic randomized trial with 6,987 smokers. Cancer Causes Control 2010; 22:167-80. [PMID: 21153694 DOI: 10.1007/s10552-010-9672-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 10/15/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED Pharmacists may be effective health care practitioners to deliver smoking cessation interventions. This paper examines the short-term outcomes of smokers randomized to one of two models of a pharmacist-led smoking cessation intervention. METHODS An open-label pragmatic randomized trial compared two models of a pharmacist-led behavioral intervention [Group A (3-sessions) vs. Group B (1-session)] in conjunction with 5 weeks of nicotine replacement therapy (NRT). Ninety-eight pharmacies in Ontario, Canada delivered the intervention. Baseline demographic and smoking behavior data were recorded, as were intervention characteristics. Self-reported, 7-day point prevalence quit rates were obtained 5-week postintervention start date. RESULTS 6,987 individuals participated; 51.4% (n = 3588) randomized to Group A; 48.6% (n = 3399) to Group B. Approximately, 50% of Group A participants completed all three sessions. Quit rates were significantly higher among Group A, 3-session completers (27.7%; n = 478) compared to Group B participants (18.0%; n = 604). Multivariable results suggest that even when controlling for possible confounders and clustering across pharmacies, Group A participants who completed all three sessions were more likely to quit compared to Group B [OR = 1.72 (95% CI: 1.53, 1.94)]. CONCLUSIONS Cessation outcomes are higher among participants completing three intervention sessions compared to one session; however, many do not return for follow-up sessions.
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