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Cardiac Rehabilitation Delivery Model for Low-Resource Settings: An International Council of Cardiovascular Prevention and Rehabilitation Consensus Statement. Prog Cardiovasc Dis 2016; 59:303-322. [PMID: 27542575 DOI: 10.1016/j.pcad.2016.08.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/15/2016] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be efficacious and cost-effective for secondary prevention in high-income countries. Given its affordability, CR should be more broadly implemented in middle-income countries as well. Hence, the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) convened a writing panel to recommend strategies to deliver all core CR components in low-resource settings, namely: (1) initial assessment, (2) lifestyle risk factor management (i.e., diet, tobacco, mental health), (3) medical risk factor management (lipids, blood pressure), (4) education for self-management; (5) return to work; and (6) outcome evaluation. Approaches to delivering these components in alternative, arguably lower-cost settings, such as the home, community and primary care, are provided. Recommendations on delivering each of these components where the most-responsible CR provider is a non-physician, such as an allied healthcare professional or community health care worker, are also provided.
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Fan H, Song F, Gu H, Wang J, Jia G, Lu M, Qian J, Wang L, Shen J, Ren Z. An assessment of factors associated with quality of randomized controlled trials for smoking cessation. Oncotarget 2016; 7:53762-53771. [PMID: 27449103 PMCID: PMC5288219 DOI: 10.18632/oncotarget.10742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/10/2016] [Indexed: 11/25/2022] Open
Abstract
To reduce smoking-related diseases, a research priority is to develop effective interventions for smoking cessation, and evidence from randomized controlled trials (RCTs) is usually considered to be the most valid. However, findings from RCTs may still be misleading due to methodological flaws. This study aims to assess the quality of 1083 RCTs of smoking cessation interventions in 41 relevant Cochrane Systematic Reviews (CSRs). Logistic regression analysis was performed to identify significant variables associated with the quality of RCTs. It was found that evidence for smoking cessation from RCTs was predominantly from high income countries, and the overall quality was high in only 8.6% of the RCTs. High quality RCTs tended to have a larger sample size, to be more recently published, and conducted in multiple countries belonging to different income categories. In conclusion, the overall quality of RCTs of smoking cessation interventions is far from perfect, and more RCTs in less developed countries are required to generate high grade evidence for global tobacco control. Collaboration between researchers in developed and less developed countries should be encouraged.
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Affiliation(s)
- Hong Fan
- Center for Health Policy and Management Research, Nanjing University, Nanjing, P.R.China
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Fujian Song
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Hai Gu
- Center for Health Policy and Management Research, Nanjing University, Nanjing, P.R.China
| | - Jianming Wang
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Guizhen Jia
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Moyuan Lu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Jiao Qian
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Lei Wang
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Jiemiao Shen
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Zhewen Ren
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
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Schwindt RG, McNelis AM, Agley J. Curricular Innovations in Tobacco Cessation Education for Prelicensure Baccalaureate Nursing Students. J Nurs Educ 2016; 55:425-31. [PMID: 27459428 DOI: 10.3928/01484834-20160715-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/02/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tobacco use is the primary preventable cause of morbidity and mortality in the United States, resulting in enormous health care expenditures. The burden of smoking is higher among disadvantaged populations, such as individuals with mental illness. As the largest group of health care providers, nurses must assume a leading role in tobacco control efforts to decrease the deleterious impact on health outcomes. METHOD Investigators used a randomized control group design to assess the effectiveness of a theory-based tobacco education program on the perceived competence and intrinsic motivation of prelicensure BSN students (N = 134) to engage in cessation interventions with patients with mental illness. RESULTS Students completing the program reported a significant increase in perceived competence, compared with their peers who received standard instruction only. Intrinsic motivation did not increase significantly for either group. CONCLUSION Findings suggest that the program improves students' perceived competence, but further research is needed to determine its effect on motivation and its usefulness in other health care contexts. [J Nurs Educ. 2016;55(8):425-431.].
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Olano-Espinosa E, Minué-Lorenzo C. ["Do not do" also as regards tobacco]. Aten Primaria 2016; 48:493-9. [PMID: 27209564 PMCID: PMC6877859 DOI: 10.1016/j.aprim.2016.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 11/16/2022] Open
Abstract
We do have very effective and efficient interventions to help our patients to stop smoking. The strategy that has more evidence and consensus in primary care is the 5 A's, that is, ask, advise, assess willingness to try to quit smoking, helping those who want to try and make follow-up visits. However, we intervene lot less than we should. The available protocols oversized interventions, and propose elements without scientific evidence or therapeutic effect. It is therefore necessary to develop more simple, useful and evidence-based interventions to assist us in carrying out our work interventions, and stop doing those that dońt contribute. In this article we will use as an example a critical review of Smoker Care Service Portfolio of Madrid Health Service, and we will propose a number of alternatives to allow a simple, effective and evidence-based intervention.
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Affiliation(s)
- Eduardo Olano-Espinosa
- Centro de Salud Los Castillos, Alcorcón, Madrid, miembro del Grupo de Abordaje al Tabaquismo (GAT) de la Sociedad Madrileña de Medicina Familiar y Comunitaria (SoMaMFyC).
| | - César Minué-Lorenzo
- Centro de Salud Perales del Río, Getafe, Madrid, coordinador del Grupo de Abordaje al Tabaquismo (GAT) de la Sociedad Madrileña de Medicina Familiar y Comunitaria (SoMaMFyC)
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Anthony D, Dyson PA, Lv J, Thankappan KR, Champgane B, Matthews DR. Community Interventions for Health can support clinicians in advising patients to reduce tobacco use, improve dietary intake and increase physical activity. J Clin Nurs 2016; 25:3167-3175. [DOI: 10.1111/jocn.13323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Denis Anthony
- University of Leeds; Leeds UK
- Harris Manchester College; University of Oxford; Oxford UK
| | - Pamela A Dyson
- Oxford Centre for Diabetes, Endocrinology & Metabolism; University of Oxford; Oxford UK
| | - Jun Lv
- School of Public Health; Peking University Health Science Center; Beijing China
| | - Kavumpurathu R Thankappan
- Centre for Health Science Studies; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Trivandrum India
| | | | - David R Matthews
- Harris Manchester College; University of Oxford; Oxford UK
- Oxford NIHR Biomedical Research Centre; Oxford UK
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Tremain D, Freund M, Wye P, Wolfenden L, Bowman J, Dunlop A, Gillham K, Bartlem K, McElwaine K, Doherty E, Wiggers J. Provision of Chronic Disease Preventive Care in Community Substance Use Services: Client and Clinician Report. J Subst Abuse Treat 2016; 68:24-30. [PMID: 27431043 DOI: 10.1016/j.jsat.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/08/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION People with substance use problems have a higher prevalence of modifiable health risk behaviors. Routine clinician provision of preventive care may be effective in reducing such health behaviors. This study aimed to examine clinician provision of preventive care to clients of community substance use treatment services. METHODS A cross-sectional survey was undertaken with 386 clients and 54 clinicians of community substance use treatment services in one health district in New South Wales, Australia. Client- and clinician-reported provision of three elements of care (assessment, brief advice and referral) for three health risk behaviors (tobacco smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity) was assessed, with associations with client characteristics examined. RESULTS Provision was highest for tobacco smoking assessment (90% client reported, 87% clinician reported) and brief advice (79% client reported, 80% clinician reported) and lowest for fruit and vegetable consumption (assessment 23%, brief advice 25%). Few clients reported being offered a referral (<10%). Assessment of physical activity and brief advice for all behaviors was higher for clients residing in rural/remote areas. CONCLUSION Assessment and brief advice were provided to the majority of clients for smoking, but sub-optimally for the other behaviors. Further investigation of barriers to the provision of preventive care within substance use treatment settings is required, particularly for referral to ongoing support.
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Affiliation(s)
- Danika Tremain
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia.
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Paula Wye
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jenny Bowman
- Hunter Medical Research Institute, New Lambton Heights, Australia; Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Adrian Dunlop
- Faculty of Health, The University of Newcastle, Callaghan, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia; Centre for Translational Neuroscience and Mental Health, Waratah, Australia
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Kate Bartlem
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Kathleen McElwaine
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Emma Doherty
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, Australia; Faculty of Health, The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
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Schultz ASH, Guzman R, Sawatzky JAV, Thurmeier R, Fedorowicz A, Fulmore K. Reframing tobacco dependency management in acute care: A case study. Health Policy 2016; 120:967-74. [PMID: 27392584 DOI: 10.1016/j.healthpol.2016.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 04/17/2016] [Accepted: 06/14/2016] [Indexed: 11/28/2022]
Abstract
Effective tobacco dependence treatment within acute care tends to be inadequate. The purpose of the Utilizing best practices to Manage Acute care patients Tobacco Dependency (UMAT) was to implement and evaluate an evidence-based intervention to support healthcare staff to effectively manage nicotine withdrawal symptoms of acute surgical patients. Data collection for this one-year longitudinal case study included: relevant patient experiences and staff reported practice, medication usage, and chart review. Over the year each data source suggested changes in tobacco dependence treatment. Key changes in patient survey responses (N=55) included a decrease in daily smoking and cigarette cravings. Of patients who used nicotine replacement therapy, they reported an increase in symptom relief. Staff (N=45) were surveyed at baseline, mid-point and end of study. Reported rates of assessing smoking status did not change over the year, but assessment of withdrawal symptoms emerged as daily practice and questions about cessation diminished. Also delivery of nicotine replacement therapy products increased over the year. Chart reviews showed a shift in content from documenting smoking behavior to withdrawal symptoms and administration of nicotine replacements; also frequency of comments increased. In summary, the evidence-based intervention influenced unit norms and reframed the culture related to tobacco dependence treatment.
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Affiliation(s)
- Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 369 Tache Avenue, CR 3022 Asper Clinical Research Institute, Winnipeg, MB R2H 2A6, Canada.
| | - Randolph Guzman
- St-Boniface General Hospital and Surgery Department Max Rady College of Medicine, Rady Faulty of Health Sciences, University of Manitoba, 351Tache Avenue, Winnipeg, MB R2H 2A6, Canada
| | - Jo-Ann V Sawatzky
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3 T 2N2, Canada
| | - Rick Thurmeier
- St-Boniface General Hospital 351 Tache Avenue, Winnipeg, MB R2H 2A6 Canada
| | - Anna Fedorowicz
- St-Boniface General Hospital 351 Tache Avenue, Winnipeg, MB R2H 2A6 Canada
| | - Kaitlin Fulmore
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 369 Tache Avenue, CR 3022 Asper Clinical Research Institute, Winnipeg, MB R2H 2A6, Canada
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Tate DF, Lytle LA, Sherwood NE, Haire-Joshu D, Matheson D, Moore SM, Loria CM, Pratt C, Ward DS, Belle SH, Michie S. Deconstructing interventions: approaches to studying behavior change techniques across obesity interventions. Transl Behav Med 2016; 6:236-43. [PMID: 27356994 PMCID: PMC4927444 DOI: 10.1007/s13142-015-0369-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Deconstructing interventions into the specific techniques that are used to change behavior represents a new frontier in behavioral intervention research. This paper considers opportunities and challenges in employing the Behavior Change Techniques Taxonomy (BCTTv1) developed by Michie and colleagues, to code the behavior change techniques (BCTs) across multiple interventions addressing obesity and capture dose received at the technique level. Numerous advantages were recognized for using a shared framework for intervention description. Coding interventions at levels of the social ecological framework beyond the individual level, separate coding for behavior change initiation vs. maintenance, fidelity of BCT delivery, accounting for BCTs mode of delivery, and tailoring BCTs, present both challenges and opportunities. Deconstructing interventions and identifying the dose required to positively impact health-related outcomes could enable important gains in intervention science.
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Affiliation(s)
- Deborah F Tate
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Leslie A Lytle
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | | | - Donna Matheson
- Department of Pediatrics & Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - Shirley M Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Charlotte Pratt
- National Heart, Lung and Blood Institute, NIH, Bethesda, MD, USA
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steven H Belle
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Susan Michie
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Challinor JM, Galassi AL, Al-Ruzzieh MA, Bigirimana JB, Buswell L, So WK, Steinberg AB, Williams M. Nursing's Potential to Address the Growing Cancer Burden in Low- and Middle-Income Countries. J Glob Oncol 2016; 2:154-163. [PMID: 28717695 PMCID: PMC5495453 DOI: 10.1200/jgo.2015.001974] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Julia M. Challinor
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Annette L. Galassi
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Majeda A. Al-Ruzzieh
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Jean Bosco Bigirimana
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Lori Buswell
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Winnie K.W. So
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Allison Burg Steinberg
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
| | - Makeda Williams
- Julia M. Challinor, International Network for Cancer Treatment and Research, Brussels, Belgium; Annette L. Galassi and Makeda Williams, National Cancer Institute, Bethesda, MD; Majeda A. Al-Ruzzieh, King Hussein Cancer Center, Amman, Jordan; Jean Bosco Bigirimana, Inshuti Mu Buzima, Rwinkwavu, Rwanda; Lori Buswell, Partners in Health, Boston, MA; Winnie K. W. So, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China; and Allison Burg Steinberg, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, Washington, DC
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Moysidou A, Farsalinos KE, Voudris V, Merakou K, Kourea K, Barbouni A. Knowledge and Perceptions about Nicotine, Nicotine Replacement Therapies and Electronic Cigarettes among Healthcare Professionals in Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13050514. [PMID: 27213421 PMCID: PMC4881139 DOI: 10.3390/ijerph13050514] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 12/28/2022]
Abstract
Introduction. The purpose of this study was to evaluate the knowledge and perceptions of Greek healthcare professionals about nicotine, nicotine replacement therapies and electronic cigarettes. Methods. An online survey was performed, in which physicians and nurses working in private and public healthcare sectors in Athens-Greece were asked to participate through email invitations. A knowledge score was calculated by scoring the correct answers to specific questions with 1 point. Results. A total of 262 healthcare professionals were included to the analysis. Most had daily contact with smokers in their working environment. About half of them considered that nicotine has an extremely or very important contribution to smoking-related disease. More than 30% considered nicotine replacement therapies equally or more addictive than smoking, 76.7% overestimated their smoking cessation efficacy and only 21.0% would recommend them as long-term smoking substitutes. For electronic cigarettes, 45.0% considered them equally or more addictive than smoking and 24.4% equally or more harmful than tobacco cigarettes. Additionally, 35.5% thought they involve combustion while the majority responded that nicotine in electronic cigarettes is synthetically produced. Only 14.5% knew about the pending European regulation, but 33.2% have recommended them to smokers in the past. Still, more than 40% would not recommend electronic cigarettes to smokers unwilling or unable to quit smoking with currently approved medications. Cardiologists and respiratory physicians, who are responsible for smoking cessation therapy in Greece, were even more reluctant to recommend electronic cigarettes to this subpopulation of smokers compared to all other participants. The knowledge score of the whole study sample was 7.7 (SD: 2.4) out of a maximum score of 16. Higher score was associated with specific physician specialties. Conclusions. Greek healthcare professionals appear to overestimate the adverse effects of nicotine, and many would not recommend any nicotine-containing product as a long-term smoking substitute. Additionally, they have poor knowledge about the function and characteristics of electronic cigarettes.
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Affiliation(s)
- Anastasia Moysidou
- National School of Public Health, Alexandras Av. 196, Athens 11521, Greece.
| | | | - Vassilis Voudris
- Onassis Cardiac Surgery Center, Sygrou 356, Kallithea 17674, Greece.
| | - Kyriakoula Merakou
- National School of Public Health, Alexandras Av. 196, Athens 11521, Greece.
| | - Kallirrhoe Kourea
- National School of Public Health, Alexandras Av. 196, Athens 11521, Greece.
| | - Anastasia Barbouni
- National School of Public Health, Alexandras Av. 196, Athens 11521, Greece.
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Brief advice and active referral for smoking cessation services among community smokers: a study protocol for randomized controlled trial. BMC Public Health 2016; 16:387. [PMID: 27169630 PMCID: PMC4866301 DOI: 10.1186/s12889-016-3084-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/30/2016] [Indexed: 11/23/2022] Open
Abstract
Background Most smokers do not use smoking cessation (SC) services although it increases successful quits. Passive referral providing SC information to smokers is commonly used in SC studies. Little was known about active referral in the community setting. This study aims to motivate community smokers to quit by brief SC advice using a validated AWARD model (Ask, Warn, Advise, Refer and Do-it-again) that adjunct with active referral of smokers to various SC services in Hong Kong. Methods/Design This is a single-blinded, parallel three-armed cluster randomized controlled trial (RCT) with two treatment groups of (1) brief SC advice using the AWARD model, active referral to SC services plus a referral card and a health warning leaflet (active referral group) and (2) brief SC advice using AWARD model and health warning leaflet (brief advice group) and a control group receives general very brief advice with a self-help booklet. A total of 1291 smokers will be recruited from 66 clusters (recruitment sessions) with 22 will be allocated to each of the two intervention and one control groups. SC ambassadors will be trained for delivering the interventions and conducting telephone follow-up. The primary outcomes are self-reported 7-days point prevalence (PP) abstinence at 3 and 6 months follow-up. Intention-to-treat principle and multi-level regressions will be used for data analysis. Discussion This is the first RCT on assessing a model combining brief advice and active referral to SC services among community smokers. The results will inform the practices of SC services and intervention studies. Trial registration NCT02539875 (ClinicalTrials.gov registry; registered retrospectively on 22 July 2015)
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de Bruin M, Viechtbauer W, Eisma MC, Hartmann-Boyce J, West R, Bull E, Michie S, Johnston M. Identifying effective behavioural components of Intervention and Comparison group support provided in SMOKing cEssation (IC-SMOKE) interventions: a systematic review protocol. Syst Rev 2016; 5:77. [PMID: 27146038 PMCID: PMC4857384 DOI: 10.1186/s13643-016-0253-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/25/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Systematic reviews of behaviour change interventions for smoking cessation vary in scope, quality, and applicability. The current review aims to generate more accurate and useful findings by (1) a detailed analysis of intervention elements that change behaviour (i.e. behaviour change techniques (BCTs)) and potential moderators of behaviour change (i.e. other intervention and sample characteristics) and (2) assessing and controlling for variability in support provided to comparison groups in smoking cessation trials. METHODS A systematic review will be conducted of randomized controlled trials of behaviour change interventions for smoking cessation in adults (with or without pharmacological support), with a minimum follow-up of 6 months, published after 1995. Eligible articles will be identified through the Cochrane Tobacco Addiction Group Specialized Register. Study authors will be asked for detailed descriptions of smoking cessation support provided to intervention and comparison groups. All data will be independently coded by two researchers. The BCT taxonomy v1 (tailored to smoking cessation interventions) and template for intervention description and replication criteria will be used to code intervention characteristics. Data collection will further include sample and trial characteristics and outcome data (smoking cessation rates). Multilevel mixed-effects meta-regression models will be used to examine which BCTs and/or BCT clusters delivered to intervention and comparison groups explain smoking cessation rates in treatment arms (and effect sizes) and what key moderators of behaviour change are. Predicted effect sizes of each intervention will be computed assuming all interventions are compared against comparison groups receiving the same levels of behavioural support (i.e. low, medium, and high levels). Multi-disciplinary advisory board members (policymakers, health care providers, and (ex-)smokers) will provide strategic input throughout the project to ensure the review's applicability to policy and practice. DISCUSSION By capturing BCTs in intervention and comparison groups, this systematic review will provide more accurate estimates of the effectiveness of smoking cessation interventions, the most promising BCTs and/or BCT clusters associated with smoking cessation rates in intervention and comparison arms, and important moderators of behaviour change. The results could set new standards for conducting meta-analyses of behaviour change interventions and improve research, service delivery, and training in the area of smoking cessation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015025251.
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Affiliation(s)
- Marijn de Bruin
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland.
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Maarten C Eisma
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Robert West
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, England
| | - Eleanor Bull
- NHS Grampian Public Health Directorate, Aberdeen, Scotland
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England
| | - Marie Johnston
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
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Effectiveness of advice from physician and nurse on smoking cessation stage in Taiwanese male smokers attending a community-based integrated screening program. Tob Induc Dis 2016; 14:15. [PMID: 27110231 PMCID: PMC4841961 DOI: 10.1186/s12971-016-0080-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 04/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A screening program provides a teachable moment for primary prevention such as encouraging smoking cessation. However, little is known about the efficacy of smoking cessation intervention delivered to the general population through a community-based screening program. METHODS A quasi-experimental untreated control design with pre-test and post-test was conducted with 42 subjects receiving advice from physician and nurses (the PNA group), 39 receiving an informational leaflet (the leaflet group), and 308 control subjects. RESULTS The overall rate of reaching the action stage was 25 %, 5.7 %, and 7.8 in the PNA group, the leaflet group, and the control group, respectively. In approximately 45-60 % of all participants, the stage remained unchanged. Such an association between the intervention groups and stage changes was statistically significant (p = 0.02). The PNA group was more likely to have the improvement of stage (forward transition toward action stage) than the control group [adjusted odds ratio (aOR) = 2.27 (1.07-4.84)]. Deterioration (backward transition toward precontemplation) in the PNA intervention group was 37 % lower than that in the control group [aOR = 0.63 (0.20-2.01)]. CONCLUSIONS This study demonstrated that smoking cessation advice from physician and nurse is conducive to smoking cessation, as shown by greater movement toward and less movement away from smoking cessation through a community-based integrated screening platform.
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Richardson M, Garner P, Donegan S. Cluster Randomised Trials in Cochrane Reviews: Evaluation of Methodological and Reporting Practice. PLoS One 2016; 11:e0151818. [PMID: 26982697 PMCID: PMC4794236 DOI: 10.1371/journal.pone.0151818] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/04/2016] [Indexed: 12/02/2022] Open
Abstract
Objective Systematic reviews can include cluster-randomised controlled trials (C-RCTs), which require different analysis compared with standard individual-randomised controlled trials. However, it is not known whether review authors follow the methodological and reporting guidance when including these trials. The aim of this study was to assess the methodological and reporting practice of Cochrane reviews that included C-RCTs against criteria developed from existing guidance. Methods Criteria were developed, based on methodological literature and personal experience supervising review production and quality. Criteria were grouped into four themes: identifying, reporting, assessing risk of bias, and analysing C-RCTs. The Cochrane Database of Systematic Reviews was searched (2nd December 2013), and the 50 most recent reviews that included C-RCTs were retrieved. Each review was then assessed using the criteria. Results The 50 reviews we identified were published by 26 Cochrane Review Groups between June 2013 and November 2013. For identifying C-RCTs, only 56% identified that C-RCTs were eligible for inclusion in the review in the eligibility criteria. For reporting C-RCTs, only eight (24%) of the 33 reviews reported the method of cluster adjustment for their included C-RCTs. For assessing risk of bias, only one review assessed all five C-RCT-specific risk-of-bias criteria. For analysing C-RCTs, of the 27 reviews that presented unadjusted data, only nine (33%) provided a warning that confidence intervals may be artificially narrow. Of the 34 reviews that reported data from unadjusted C-RCTs, only 13 (38%) excluded the unadjusted results from the meta-analyses. Conclusions The methodological and reporting practices in Cochrane reviews incorporating C-RCTs could be greatly improved, particularly with regard to analyses. Criteria developed as part of the current study could be used by review authors or editors to identify errors and improve the quality of published systematic reviews incorporating C-RCTs.
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Affiliation(s)
- Marty Richardson
- Centre for Evidence Synthesis in Global Health, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sarah Donegan
- Department of Biostatistics, Block F Waterhouse Building, University of Liverpool, Liverpool, United Kingdom
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Ortega-García JA, Perales JE, Cárceles-Álvarez A, Sánchez-Sauco MF, Villalona S, Mondejar-López P, Pastor-Vivero MD, Mira Escolano P, James-Vega DC, Sánchez-Solís M. Long term follow-up of a tobacco prevention and cessation program in cystic fibrosis patients. Adicciones 2016; 28:99-107. [PMID: 26990263 DOI: 10.20882/adicciones.778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study evaluates the impact over time of a telephone-based intervention in tobacco cessation and prevention targeting patients with cystic fibrosis (CF) in the Mediterranean region of Murcia, Spain. We conducted an experimental prospective study with a cohort of CF patients using an integrative smoking cessation programme, between 2008 and 2013. The target population included family members and patients from the Regional CF unit. The study included an initial tobacco exposure questionnaire, measurement of lung function, urinary cotinine levels, anthropomorphic measures and the administered intervention at specific time intervals. Of the 88 patients tracked through follow-up, active smoking rates were reduced from 10.23% to 4.55% (p = 0.06). Environmental tobacco exposure was reduced in non-smoker patients from 62.03% to 36.90% (p < 0.01) during the five year follow-up. Significant reductions in the gradient of household tobacco smoke exposure were also observed with a decrease of 12.60%, from 31.65% (n = 25/79) to 19.05% (n = 16/84) in 2013 (p = <0.01). Cotinine was significantly correlated with both active and passive exposure (p<0.01) with a significant reduction of cotinine levels from 63.13 (28.58-97.69) to 20.56 (0.86-40.27) ng/ml (p<0.01). The intervention to significantly increase the likelihood of family quitting (smoke-free home) was 1.26 (1.05-1.54). Telephone based interventions for tobacco cessation and prevention is a useful tool when applied over time. Trained intervention professionals in this area are needed in the environmental health approach for the treatment of CF.
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Zeng L, Yu X, Yu T, Xiao J, Huang Y. Interventions for smoking cessation in people diagnosed with lung cancer. Cochrane Database Syst Rev 2015:CD011751. [PMID: 26632766 DOI: 10.1002/14651858.cd011751.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Lung cancer is one of the most common causes of death from cancer worldwide. Smoking induces and aggravates many health problems, including vascular diseases, respiratory illnesses and cancers. Tobacco smoking constitutes the most important risk factor for lung cancer. Most people with lung cancer are still active smokers at diagnosis or frequently relapse after smoking cessation. Quitting smoking is the most effective way for smokers to reduce the risk of premature death and disability. People with lung cancer may benefit from stopping smoking. Whether smoking cessation interventions are effective for people with lung cancer and whether one method of quitting is more effective than any other has not been systematically reviewed. OBJECTIVES To determine the effectiveness of smoking cessation programmes for people with lung cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (accessed via PubMed) and EMBASE up to 22 June 2015. We also searched the American Society of Clinical Oncology (ASCO) Annual Meeting proceedings, the lung cancer sections of the proceedings of the ESMO Congress, the lung cancer sections of the proceedings of the European Conference of Clinical Oncology (ECCO) Congress, the World Conference on Lung Cancer proceedings, the Society for Research on Nicotine and Tobacco Annual Meeting from 2013, the Food and Drug Administration website, the European Medicine Agency for drug registration website, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, ClinicalTrials.gov, and the metaRegister of Controlled Trials (mRCT) to 1 July 2015. We applied no restriction on language of publication. SELECTION CRITERIA We planned to include any randomised controlled trial (RCT) of any psychosocial or pharmacological smoking cessation intervention or combinations of both, compared with no intervention, a different psychosocial or pharmacological (or both) intervention or placebo for pharmacological interventions in people with lung cancer. DATA COLLECTION AND ANALYSIS Two review authors independently screened the studies from the initial search for potential trials for inclusion. We planned to use standard methodological procedures expected by Cochrane. We found no trials that met the inclusion criteria. MAIN RESULTS We identified no RCTs that met our inclusion criteria. Among the 1052 records retrieved using our search strategy, we retrieved 13 studies for further investigation. We excluded 10 trials: five trials because we could not distinguish people with lung cancer from the other participants, or the participants were not people with lung cancer, four because they were not randomised, or RCTs. We excluded one trial because, though it was completed in 2004, no results are available. We assessed three ongoing trials for inclusion when data become available. AUTHORS' CONCLUSIONS There were no RCTs that determined the effectiveness of any type of smoking cessation programme for people with lung cancer. There was insufficient evidence to determine whether smoking cessation interventions are effective for people with lung cancer and whether one programme is more effective than any other. People with lung cancer should be encouraged to quit smoking and offered smoking cessation interventions. However, due to the lack of RCTs, the efficacy of smoking cessation interventions for people with lung cancer cannot be evaluated and concluded. This systematic review identified a need for RCTs to explore these.
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Affiliation(s)
- Linmiao Zeng
- Department of Respiratory Medicine, Mindong Hospital Affiliated to Fujian Medical University, No. 89, He'shan Road, Fu'an City, Fujian Province, China, 355000
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Choi SH, Kim YH. Factors Affecting Korean Registered Nurses' Intention to Implement Smoking Cessation Intervention. Osong Public Health Res Perspect 2015; 7:63-70. [PMID: 26981345 PMCID: PMC4776271 DOI: 10.1016/j.phrp.2015.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/30/2015] [Accepted: 11/23/2015] [Indexed: 12/01/2022] Open
Abstract
Objectives Nurses have been identified as an instrumental partner in tobacco reduction. This study aimed to examine factors affecting Korean nurses' intention to implement smoking cessation intervention in Busan, Korea. Methods The participants were a total of 215 Korean registered nurses. A self-administered questionnaire evaluated predisposing factors, motivational factors (attitude, social influence, and self-efficacy) and intention to implement smoking cessation intervention. Data were analyzed by t tests, Pearson's correlation, and hierarchical multiple regression. Results The mean age of the participants was 28.12 ± 5.72 years. The majority of the participants were staff nurses (85.6%), and 64.2% of the sample had < 5 years of work experience. Significant predictors of intention to implement smoking cessation intervention included perceived barrier of smoking cessation intervention (β = −0.128, p = 0.023), willingness to receive smoking cessation training (β = 0.123, p = 0.034), more positive attitude (β = 0.203, p = 0.002), higher social influence (β = 0.292, p < 0.001), and higher self-efficacy toward smoking cessation intervention (β = 0.151, p = 0.021), which explained 45% of the total variance of intention to implement smoking cessation intervention. Conclusion Attitude, social influence, and self-efficacy towards smoking cessation intervention had a significant positive influence in determining the intention to implement smoking cessation intervention. These findings can be used to develop evidence-based smoking cessation training programs for nurses in Korea. The programs should aim for positive attitude, higher social influence, and higher self-efficacy in hospital settings.
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Affiliation(s)
- Sook-Hee Choi
- Department of Nursing, Youngsan University, Yangsansi, Korea
| | - Yun-Hee Kim
- Department of Nursing, Pukyong National University, Busan, Korea
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Patnode CD, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force. Ann Intern Med 2015; 163:608-21. [PMID: 26389650 DOI: 10.7326/m15-0171] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tobacco use is the leading cause of preventable death in the United States. PURPOSE To review the effectiveness and safety of pharmacotherapy and behavioral interventions for tobacco cessation. DATA SOURCES 5 databases and 8 organizational Web sites were searched through 1 August 2014 for systematic reviews, and PubMed was searched through 1 March 2015 for trials on electronic nicotine delivery systems. STUDY SELECTION Two reviewers examined 114 articles to identify English-language reviews that reported health, cessation, or adverse outcomes. DATA EXTRACTION One reviewer abstracted data from good- and fair-quality reviews, and a second checked for accuracy. DATA SYNTHESIS 54 reviews were included. Behavioral interventions increased smoking cessation at 6 months or more (physician advice had a pooled risk ratio [RR] of 1.76 [95% CI, 1.58 to 1.96]). Nicotine replacement therapy (RR, 1.60 [CI, 1.53 to 1.68]), bupropion (RR, 1.62 [CI, 1.49 to 1.76]), and varenicline (RR, 2.27 [CI, 2.02 to 2.55]) were also effective for smoking cessation. Combined behavioral and pharmacotherapy interventions increased cessation by 82% compared with minimal intervention or usual care (RR, 1.82 [CI, 1.66 to 2.00]). None of the drugs were associated with major cardiovascular adverse events. Only 2 trials addressed efficacy of electronic cigarettes for smoking cessation and found no benefit. Among pregnant women, behavioral interventions benefited cessation and perinatal health; effects of nicotine replacement therapy were not significant. LIMITATION Evidence published after each review's last search date was not included. CONCLUSION Behavioral and pharmacotherapy interventions improve rates of smoking cessation among the general adult population, alone or in combination. Data on the effectiveness and safety of electronic nicotine delivery systems are limited. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Carrie D. Patnode
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jillian T. Henderson
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jamie H. Thompson
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Caitlyn A. Senger
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Stephen P. Fortmann
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Evelyn P. Whitlock
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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Siu AL. Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2015; 163:622-34. [PMID: 26389730 DOI: 10.7326/m15-2023] [Citation(s) in RCA: 310] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION Update of the 2009 U.S. Preventive Services Task Force (USPSTF) recommendation on counseling and interventions to prevent tobacco use and tobacco-related disease in adults, including pregnant women. METHODS The USPSTF reviewed the evidence on interventions for tobacco smoking cessation that are relevant to primary care (behavioral interventions, pharmacotherapy, and complementary or alternative therapy) in adults, including pregnant women. POPULATION This recommendation applies to adults aged 18 years or older, including pregnant women. RECOMMENDATIONS The USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration-approved pharmacotherapy for cessation to adults who use tobacco. (A recommendation). The USPSTF recommends that clinicians ask all pregnant women about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant women who use tobacco. (A recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant women. (I statement). The USPSTF concludes that the current evidence is insufficient to recommend electronic nicotine delivery systems for tobacco cessation in adults, including pregnant women. The USPSTF recommends that clinicians direct patients who smoke tobacco to other cessation interventions with established effectiveness and safety (previously stated). (I statement).
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Affiliation(s)
- Albert L. Siu
- From the U.S. Preventive Services Task Force, Rockville, Maryland
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Faulkner K, Sutton S, Jamison J, Sloan M, Boase S, Naughton F. Are Nurses and Auxiliary Healthcare Workers Equally Effective in Delivering Smoking Cessation Support in Primary Care? Nicotine Tob Res 2015; 18:1054-60. [PMID: 26453668 PMCID: PMC4826488 DOI: 10.1093/ntr/ntv206] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 08/29/2015] [Indexed: 11/23/2022]
Abstract
Introduction: Smoking cessation support is increasingly delivered in primary care by auxiliary healthcare workers in place of healthcare professionals. However, it is unknown whether this shift might affect the quality and impact of the support delivered. Methods: Data from the iQuit in Practice randomized control trial of cessation support in General Practice was used (N = 602). Analyses assessed whether cessation advisor type (nurse or healthcare assistant [HCA]) was associated with abstinence (primary outcome: self-reported 2-week point prevalence abstinence at 8 weeks follow-up), the advice delivered during the initial consultation, pharmacotherapies prescribed, patient satisfaction, initial consultation length, and the number and type of interim contacts. Results: There were no statistically significant differences in abstinence for support delivered by HCAs versus nurses at 8 weeks (HCAs 42.8%, nurses 42.6%; unadjusted odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.73 to 1.40), or at 4 weeks or 6 months follow-up. There were no statistically significant differences in advice delivered, the types of pharmacotherapies prescribed or patient satisfaction. Compared with nurses, HCA consultations were longer on average (HCAs 23.6 minutes, nurses 20.8 minutes; P = .002) and they undertook more interim contacts (HCAs median 2, nurses median 1; P < .001), with contact more likely to be face-to-face than phone call (HCAs 91.2%, nurses 70.9%; OR = 4.23, 95% CI = 2.86 to 6.26). Conclusions: HCAs appear equally effective as nurses in supporting smoking cessation, although they do this with greater patient contact. Using auxiliary practitioners to deliver cessation support could free up nurse time and reduce costs. Implications: This study found that primary care patients receiving smoking cessation support from auxiliary healthcare workers were just as likely to be abstinent up to 6 months later as those patients seen by nurses. While the auxiliary healthcare workers achieved this with slightly increased patient contact time, the advice delivered, pharmacotherapies provided and patient satisfaction were similar to that of nurses. Expanding the auxiliary healthcare worker role to include smoking cessation support could increase role satisfaction and reduce the costs of cessation support delivery in primary care.
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Affiliation(s)
- Kathryn Faulkner
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Sutton
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - James Jamison
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - Melanie Sloan
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - Sue Boase
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
| | - Felix Naughton
- Behavioural Science Group, University of Cambridge, Cambridge, United Kingdom
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Pardavila-Belio MI, García-Vivar C, Pimenta AM, Canga-Armayor A, Pueyo-Garrigues S, Canga-Armayor N. Intervention study for smoking cessation in Spanish college students: pragmatic randomized controlled trial. Addiction 2015; 110:1676-83. [PMID: 26053958 DOI: 10.1111/add.13009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/28/2015] [Accepted: 05/29/2015] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effectiveness of a nurse intervention aimed at helping college student smokers quit smoking. DESIGN Single-blind, pragmatic randomized controlled trial which compares a multi-component intervention, tailored specifically to college students, with a brief advice session with a 6-month follow-up. SETTINGS This study was conducted at the University of Navarra, Spain. PARTICIPANTS A total of 255 college student smokers (age range = 18-24 years) were randomized to an intervention group (n = 133) or to a control group (n = 122). INTERVENTION A multi-component intervention based on the Theory of Triadic Influence of Flay was developed. The intervention consisted of a 50-minute motivational interview conducted by a nurse and online self-help material. The follow-up included a reinforcing e-mail and group therapy. MEASUREMENTS The primary outcome was self-reported abstinence, with biochemical verification at 6 months. The secondary outcomes consisted of the mean number of cigarettes smoked per day, self-reported attempts to quit smoking and stage of change at 6 months. FINDINGS At the 6-month follow-up, the smoking cessation incidence was 21.1% in the intervention group compared with 6.6% in the control group (difference = 14.5 confidence interval = 6.1-22.8; relative risk = 3.41, 95% confidence interval = 1.62-7.20). The difference in the mean number of cigarettes at 6 months was significantly different (difference = -2.2, confidence interval = -3.6 to -0.9). CONCLUSIONS A multi-component intervention tailored to college students and managed by a nurse is effective in increasing smoking cessation among college students.
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Affiliation(s)
- Miren I Pardavila-Belio
- Department of Community Nursing and Maternal and Child Health Care, University of Navarra, Pamplona, Navarra, Spain
| | - Cristina García-Vivar
- Department of Community Nursing and Maternal and Child Health Care, University of Navarra, Pamplona, Navarra, Spain
| | - Adriano Marçal Pimenta
- Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Canga-Armayor
- Department of Psychiatry and Psychology, University Clinic of Navarra, Pamplona, Navarra, Spain
| | - Sara Pueyo-Garrigues
- Department of Nursing Care for Adults, University of Navarra, Pamplona, Navarra, Spain
| | - Navidad Canga-Armayor
- Department of Community Nursing and Maternal and Child Health Care, University of Navarra, Pamplona, Navarra, Spain
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Sarna L, Bialous SA, Zou XN, Wang W, Hong J, Chan S, Wells MJ, Brook J. Helping smokers quit: behaviours and attitudes of Chinese Registered Nurses. J Adv Nurs 2015; 72:107-17. [PMID: 26411961 DOI: 10.1111/jan.12811] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 12/21/2022]
Abstract
AIMS To describe the self-reported frequency of Chinese nurses' interventions to help smokers quit, using the 5 As (i.e. Ask, Advise, Assess, Assist, Arrange), attitudes towards tobacco control and differences in consistency interventions by demographic and professional characteristics prior to an educational intervention to increase nurses' support for quit efforts. BACKGROUND Tobacco use is the leading cause of preventable death in China; quitting smoking reduces health risks and premature death. The China Tobacco Cessation Treatment Guideline supports the 5 As model for intervention, but nurses' frequency of delivering smoking cessation interventions is unknown. DESIGN Descriptive survey using a convenience sample. METHODS Nurses from eight hospitals in Beijing and Hefei, China completed a web-based survey in 2012. Differences in consistency of the 5 As by nurse characteristics were determined using multivariate logistic regression. Overall importance of nurses in tobacco control was evaluated on a 1-5 scale (5 = most important). RESULTS Nurses (N = 2440; 1404 Beijing, 1036 Hefei) participated. 64% consistently asked about smoking status, 85% advised patients to quit, 52% assessed readiness to quit and assisted with smoking cessation and 17% arranged for follow-up. Interventions varied by nurses' education and clinical setting. Nurses positively viewed involvement in tobacco control (4·3/5) and thought nurses should be smoke-free role models (4·8/5·0). CONCLUSIONS This study demonstrates that the majority of nurses asked about smoking status, but few assisted patients with quitting. Further efforts are needed to help nurses actively promote smoking cessation interventions.
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Affiliation(s)
- Linda Sarna
- School of Nursing, University of California, Los Angeles, California, USA
| | | | - Xiao Nong Zou
- Office of Tobacco Control, National Office for Cancer Prevention and Cancer Control, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Weili Wang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Jingfang Hong
- School of Nursing, Anhui Medical University, Hefei, China
| | - Sophia Chan
- School of Nursing, The University of Hong Kong, China
| | - Marjorie J Wells
- School of Nursing, University of California, Los Angeles, California, USA
| | - Jenny Brook
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Knobf M, Cooley M, Duffy S, Doorenbos A, Eaton L, Given B, Mayer D, McCorkle R, Miaskowski C, Mitchell S, Sherwood P, Bender C, Cataldo J, Hershey D, Katapodi M, Menon U, Schumacher K, Sun V, Ah D, LoBiondo-Wood G, Mallory G. The 2014–2018 Oncology Nursing Society Research Agenda. Oncol Nurs Forum 2015; 42:450-65. [DOI: 10.1188/15.onf.450-465] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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West R, Raw M, McNeill A, Stead L, Aveyard P, Bitton J, Stapleton J, McRobbie H, Pokhrel S, Lester‐George A, Borland R. Health-care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction 2015; 110:1388-403. [PMID: 26031929 PMCID: PMC4737108 DOI: 10.1111/add.12998] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 03/10/2015] [Accepted: 05/22/2015] [Indexed: 12/11/2022]
Abstract
AIMS This paper provides a concise review of the efficacy, effectiveness and affordability of health-care interventions to promote and assist tobacco cessation, in order to inform national guideline development and assist countries in planning their provision of tobacco cessation support. METHODS Cochrane reviews of randomized controlled trials (RCTs) of major health-care tobacco cessation interventions were used to derive efficacy estimates in terms of percentage-point increases relative to comparison conditions in 6-12-month continuous abstinence rates. This was combined with analysis and evidence from 'real world' studies to form a judgement on the probable effectiveness of each intervention in different settings. The affordability of each intervention was assessed for exemplar countries in each World Bank income category (low, lower middle, upper middle, high). Based on World Health Organization (WHO) criteria, an intervention was judged as affordable for a given income category if the estimated extra cost of saving a life-year was less than or equal to the per-capita gross domestic product for that category of country. RESULTS Brief advice from a health-care worker given opportunistically to smokers attending health-care services can promote smoking cessation, and is affordable for countries in all World Bank income categories (i.e. globally). Proactive telephone support, automated text messaging programmes and printed self-help materials can assist smokers wanting help with a quit attempt and are affordable globally. Multi-session, face-to-face behavioural support can increase quit success for cigarettes and smokeless tobacco and is affordable in middle- and high-income countries. Nicotine replacement therapy, bupropion, nortriptyline, varenicline and cytisine can all aid quitting smoking when given with at least some behavioural support; of these, cytisine and nortriptyline are affordable globally. CONCLUSIONS Brief advice from a health-care worker, telephone helplines, automated text messaging, printed self-help materials, cytisine and nortriptyline are globally affordable health-care interventions to promote and assist smoking cessation. Evidence on smokeless tobacco cessation suggests that face-to-face behavioural support and varenicline can promote cessation.
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Affiliation(s)
- Robert West
- Cancer Research UK Health Behaviour Research CentreUniversity College LondonLondonUK
| | - Martin Raw
- Special Lecturer, UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - Ann McNeill
- Professor of Tobacco Addiction, King's College London, UK Centre for Tobacco and Alcohol StudiesNational Addiction CentreLondonUK
| | - Lindsay Stead
- Cochrane Tobacco Addiction Group, Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Paul Aveyard
- Professor of Behavioural Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory QuarterUniversity of OxfordOxfordUK
| | - John Bitton
- Professor of Epidemiology, UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - John Stapleton
- Reader in Addiction Statistical Analysis, Addictions Department, Institute of PsychiatryKings College LondonLondonUK
| | - Hayden McRobbie
- Reader in Public Health Interventions, Wolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUK
| | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | | | - Ron Borland
- Cancer Council Victoria, Melbourne, VictoriaAustralia
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Barth J, Jacob T, Daha I, Critchley JA. Psychosocial interventions for smoking cessation in patients with coronary heart disease. Cochrane Database Syst Rev 2015; 2015:CD006886. [PMID: 26148115 PMCID: PMC11064764 DOI: 10.1002/14651858.cd006886.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This is an update of a Cochrane review previously published in 2008. Smoking increases the risk of developing atherosclerosis but also acute thrombotic events. Quitting smoking is potentially the most effective secondary prevention measure and improves prognosis after a cardiac event, but more than half of the patients continue to smoke, and improved cessation aids are urgently required. OBJECTIVES This review aimed to examine the efficacy of psychosocial interventions for smoking cessation in patients with coronary heart disease in short-term (6 to 12 month follow-up) and long-term (more than 12 months). Moderators of treatment effects (i.e. intervention types, treatment dose, methodological criteria) were used for stratification. SEARCH METHODS The Cochrane Central Register of Controlled Trials (Issue 12, 2012), MEDLINE, EMBASE, PsycINFO and PSYNDEX were searched from the start of the database to January 2013. This is an update of the initial search in 2003. Results were supplemented by cross-checking references, and handsearches in selected journals and systematic reviews. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) in patients with CHD with a minimum follow-up of 6 months. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility and risk of bias. Abstinence rates were computed according to an intention to treat analysis if possible, or if not according to completer analysis results only. Subgroups of specific intervention strategies were analysed separately. The impact of study quality on efficacy was studied in a moderator analysis. Risk ratios (RR) were pooled using the Mantel-Haenszel and random-effects model with 95% confidence intervals (CI). MAIN RESULTS We found 40 RCTs meeting inclusion criteria in total (21 trials were new in this update, 5 new trials contributed to long-term results (more than 12 months)). Interventions consist of behavioural therapeutic approaches, telephone support and self-help material and were either focused on smoking cessation alone or addressed several risk factors (eg. obesity, inactivity and smoking). The trials mostly included older male patients with CHD, predominantly myocardial infarction (MI). After an initial selection of studies three trials with implausible large effects of RR > 5 which contributed to substantial heterogeneity were excluded. Overall there was a positive effect of interventions on abstinence after 6 to 12 months (risk ratio (RR) 1.22, 95% confidence interval (CI) 1.13 to 1.32, I² 54%; abstinence rate treatment group = 46%, abstinence rate control group 37.4%), but heterogeneity between trials was substantial. Studies with validated assessment of smoking status at follow-up had similar efficacy (RR 1.22, 95% CI 1.07 to 1.39) to non-validated trials (RR 1.23, 95% CI 1.12 to 1.35). Studies were stratified by intervention strategy and intensity of the intervention. Clustering reduced heterogeneity, although many trials used more than one type of intervention. The RRs for different strategies were similar (behavioural therapies RR 1.23, 95% CI 1.12 to 1.34, I² 40%; telephone support RR 1.21, 95% CI 1.12 to 1.30, I² 44%; self-help RR 1.22, 95% CI 1.12 to 1.33, I² 40%). More intense interventions (any initial contact plus follow-up over one month) showed increased quit rates (RR 1.28, 95% CI 1.17 to 1.40, I² 58%) whereas brief interventions (either one single initial contact lasting less than an hour with no follow-up, one or more contacts in total over an hour with no follow-up or any initial contact plus follow-up of less than one months) did not appear effective (RR 1.01, 95% CI 0.91 to 1.12, I² 0%). Seven trials had long-term follow-up (over 12 months), and did not show any benefits. Adverse side effects were not reported in any trial. These findings are based on studies with rather low risk of selection bias but high risk of detection bias (namely unblinded or non validated assessment of smoking status). AUTHORS' CONCLUSIONS Psychosocial smoking cessation interventions are effective in promoting abstinence up to 1 year, provided they are of sufficient duration. After one year, the studies showed favourable effects of smoking cessation intervention, but more studies including cost-effectiveness analyses are needed. Further studies should also analyse the additional benefit of a psychosocial intervention strategy to pharmacological therapy (e.g. nicotine replacement therapy) compared with pharmacological treatment alone and investigate economic outcomes.
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Affiliation(s)
- Jürgen Barth
- University of BernInstitute of Social and Preventive MedicineNiesenweg 6BernSwitzerlandCH‐3012
| | - Tiffany Jacob
- University of BernInstitute of Social and Preventive MedicineNiesenweg 6BernSwitzerlandCH‐3012
| | - Ioana Daha
- Carol Davila University of Medicine and Pharmacy, Colentina Clinical HospitalDepartment of Cardiology19‐21, Stefan cel MareBucharestRomania020142
| | - Julia A Critchley
- St George's, University of LondonPopulation Health Sciences InstituteCranmer TerraceLondonUKSW17 0RE
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Zeng L, Yu X, Yu T, Xiao J, Huang Y. Interventions for smoking cessation in people diagnosed with lung cancer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help people to a make a successful attempt to quit smoking. OBJECTIVES To determine whether or not motivational interviewing (MI) promotes smoking cessation. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register for studies using the term motivat* NEAR2 (interview* OR enhanc* OR session* OR counsel* OR practi* OR behav*) in the title or abstract, or motivation* as a keyword. Date of the most recent search: August 2014. SELECTION CRITERIA Randomized controlled trials in which motivational interviewing or its variants were offered to tobacco users to assist cessation. DATA COLLECTION AND ANALYSIS We extracted data in duplicate. The main outcome measure was abstinence from smoking after at least six months follow-up. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. We counted participants lost to follow-up as continuing smoking or relapsed. We performed meta-analysis using a fixed-effect Mantel-Haenszel model. MAIN RESULTS We identified 28 studies published between 1997 and 2014, involving over 16,000 participants. MI was conducted in one to six sessions, with the duration of each session ranging from 10 to 60 minutes. Interventions were delivered by primary care physicians, hospital clinicians, nurses or counsellors. Our meta-analysis of MI versus brief advice or usual care yielded a modest but significant increase in quitting (risk ratio (RR) 1.26; 95% confidence interval (CI) 1.16 to 1.36; 28 studies; N = 16,803). Subgroup analyses found that MI delivered by primary care physicians resulted in an RR of 3.49 (95% CI 1.53 to 7.94; 2 trials; N = 736). When delivered by counsellors the RR was smaller (1.25; 95% CI 1.15 to 1.63; 22 trials; N = 13,593) but MI still resulted in higher quit rates than brief advice or usual care. When we compared MI interventions conducted through shorter sessions (less than 20 minutes per session) to controls, this resulted in an RR of 1.69 (95% CI 1.34 to 2.12; 9 trials; N = 3651). Single-session treatments might increase the likelihood of quitting over multiple sessions, but both regimens produced positive outcomes. Evidence is unclear at present on the optimal number of follow-up calls.There was variation across the trials in treatment fidelity. All trials used some variant of motivational interviewing. Critical details in how it was modified for the particular study population, the training of therapists and the content of the counselling were sometimes lacking from trial reports. AUTHORS' CONCLUSIONS Motivational interviewing may assist people to quit smoking. However, the results should be interpreted with caution, due to variations in study quality, treatment fidelity, between-study heterogeneity and the possibility of publication or selective reporting bias.
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Affiliation(s)
- Nicola Lindson-Hawley
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, Oxfordshire, UK, OX2 6GG
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Spanier AJ, Beck AF, Huang B, McGrady ME, Drotar DD, Peake RWA, Kellogg MD, Kahn RS. Family hardships and serum cotinine in children with asthma. Pediatrics 2015; 135:e416-23. [PMID: 25583915 PMCID: PMC4306794 DOI: 10.1542/peds.2014-1748] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE A better understanding of how poverty-related hardships affect child health could highlight remediable intervention targets. Tobacco smoke exposure may be 1 such consequence of family hardship. Our objective was to explore the relationship between family hardships and tobacco exposure, as measured by serum cotinine, a tobacco metabolite, among children hospitalized for asthma. METHODS We prospectively enrolled a cohort of 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing. The primary outcome was detectable serum cotinine. We assessed family hardships, including 11 financial and social variables, through a survey of the child's caregiver. We used logistic regression to evaluate associations between family hardship and detectable cotinine. RESULTS We had complete study data for 675 children; 57% were African American, and 74% were enrolled in Medicaid. In total, 56% of children had detectable cotinine. More than 80% of families reported ≥ 1 hardship, and 41% reported ≥ 4 hardships. Greater numbers of hardships were associated with greater odds of having detectable cotinine. Compared with children in families with no hardships, those in families with ≥ 4 hardships had 3.7-fold (95% confidence interval, 2.0-7.0) greater odds of having detectable serum cotinine in adjusted analyses. Lower parental income and educational attainment were also independently associated with detectable serum cotinine. CONCLUSIONS Family hardships are prevalent and associated with detectable serum cotinine level among children with asthma. Family hardships and tobacco smoke exposure may be possible targets for interventions to reduce health disparities.
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Affiliation(s)
- Adam J Spanier
- Department of Pediatrics, Penn State Milton S. Hershey Children's Hospital, Hershey, Pennsylvania;
| | - Andrew F Beck
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
| | - Bin Huang
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
| | - Meghan E McGrady
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
| | - Dennis D Drotar
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
| | - Roy W A Peake
- Clinical Epidemiologic Research Laboratory, Boston Children's Hospital, Boston, Massachusetts
| | - Mark D Kellogg
- Clinical Epidemiologic Research Laboratory, Boston Children's Hospital, Boston, Massachusetts
| | - Robert S Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
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Awad AI, Alsaleh FM. 10-year risk estimation for type 2 diabetes mellitus and coronary heart disease in Kuwait: a cross-sectional population-based study. PLoS One 2015; 10:e0116742. [PMID: 25629920 PMCID: PMC4309592 DOI: 10.1371/journal.pone.0116742] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 12/12/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM), coronary heart disease (CHD) and metabolic syndrome (MetS) are major healthcare problems in Kuwait. The present study was designed to determine the prevalence of MetS, and to estimate the 10-year risk for developing T2DM and CHD among the general population in Kuwait. METHODS A descriptive, cross-sectional survey was undertaken in 1800 individuals without diabetes or a history of cardiovascular disease (CVD). They were selected from six governorates using two stage convenience sampling. The questionnaire was developed using the Finnish Diabetes Risk Score (FINDRISK), Framingham Risk Score [FRS] and the 2009 Joint Statement criteria for diagnosis of MetS as a framework. Descriptive and multivariate logistic regression analyses were used. RESULTS The response rate was 89.4%. More than half (60.8%; 95% CI: 58.4-63.2) of responders were either overweight or obese. One hundred and ninety seven (12.2%) subjects had blood pressure (BP) ≥ 140/90 mm Hg. Almost three-in-ten (28.3%: 26.2-30.6) subjects had fasting plasma glucose (FPG) levels ≥ 5.6 mmol/l, of whom 86.0% and 14.0% had impaired fasting glucose (IFG) and screen detected T2DM, respectively. MetS was present in 512 (31.8%; 29.5-34.2) respondents. Just under one third (n = 481; 29.9%; 27.7-32.2) of participants were at moderate, high, or very high risk of developing T2DM, while 283 (17.6%: 15.8-19.6) were at moderate/high 10-year risk of developing CHD. Approximately one-in-ten (8.5%; 7.2-9.9) subjects were at moderate/high/very high 10-year risk of developing both T2DM/CHD. T2DM risk was higher for females compared to males (p < 0.001); however, the pattern was reversed in terms of the risk of developing CHD or T2DM/CHD. The risk of developing T2DM, CHD, or T2DM/CHD was greater among those aged ≥ 45 years, and those having MetS (p<0.001). CONCLUSIONS The current findings highlight the need for multifaceted interventions for prevention.
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de Bruin M, McCambridge J, Prins JM. Reducing the risk of bias in health behaviour change trials: improving trial design, reporting or bias assessment criteria? A review and case study. Psychol Health 2014; 30:8-34. [PMID: 25112431 DOI: 10.1080/08870446.2014.953531] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE It has been suggested that randomised controlled trials (RCTs) of health behaviour change (HBC) interventions are less rigorously designed than - for example- drug trials. This study presents an approach to clarifying whether this is due to poor trial design, incomplete trial reporting and/or the inappropriateness of commonly applied risk of bias assessment criteria. DESIGN First, a framework of key sources of bias and common strategies for reducing bias risk is developed based on a literature review. Second, we describe the design of a multi-site RCT evaluating the cost-effectiveness of an HIV-treatment adherence intervention (case study). The choices made by the multidisciplinary team trying to minimise the risk of bias are compared against the risk of bias framework. MAIN OUTCOME MEASURES Implementation of common strategies for reducing the risk of bias in the case study; alternative or additional strategies applied; a justification for each deviation from the risk of bias framework. RESULTS Most of the common strategies for reducing the risk of bias could be implemented. Alternative strategies were developed for minimising the risk of performance bias and contamination. Several additional, domain-specific risk of bias strategies were implemented. CONCLUSIONS The literature provides useful guidance for reducing the risk of bias in HBC trials. Yet, the case study suggests that HBC trial designers may face specific challenges that require alternative/additional measures for reducing the risk of bias. Using the risk of bias justification table (RATIONALE) could lead to better-designed HBC trials, more comprehensive trial reports and the data necessary for evaluating the appropriateness of commonly applied risk of bias assessment criteria to HBC trials.
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Affiliation(s)
- Marijn de Bruin
- a Aberdeen Health Psychology Group , Institute of Applied Health Sciences, University of Aberdeen , Aberdeen , UK
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81
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Affiliation(s)
- David Mant
- University of Oxford, Department of Primary Care Health Sciences, Oxford, UK
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Hartmann-Boyce J, Stead LF, Cahill K, Lancaster T. Efficacy of interventions to combat tobacco addiction: Cochrane update of 2013 reviews. Addiction 2014; 109:1414-25. [PMID: 24995905 DOI: 10.1111/add.12633] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/22/2014] [Accepted: 05/22/2014] [Indexed: 11/28/2022]
Abstract
AIMS The Cochrane Collaboration is an international not-for profit organization which produces and disseminates systematic reviews. This paper is the second in a series of annual updates of Cochrane reviews on tobacco addiction interventions, covering new and updated reviews from 2013. METHODS In 2013, the Group published two new reviews and updated 11 others. This update summarizes and comments on these reviews as well as on a review of psychosocial interventions for smoking cessation in pregnant women, and presents pooled results from reviews of cessation interventions. RESULTS New reviews in 2013 found: low-quality evidence that behavioural interventions with mood management components could significantly increase long-term quit rates in people with current [risk ratio (RR) = 1.47, 95% confidence interval (CI) = 1.13-1.92) and past (RR = 1.41, 95% CI = 1.13-1.77] depression; evidence from network meta-analysis that varenicline and combined forms of nicotine replacement therapy (NRT) are associated with higher quit rates than bupropion or single-form NRT (varenicline versus single-form NRT odds ratio (OR) = 1.57, 95% credibility interval (CredI) = 1.29-1.91; versus bupropion OR = 1.59, 95% CredI = 1.29-1.96); and no evidence of a significant increase in serious adverse events in trial participants randomized to varenicline or bupropion when compared to placebo controls. New evidence emerging from updated reviews suggests that counselling interventions can increase quit rates in pregnant women and that school-based smoking programmes with social competence curricula can lead to a significant reduction in uptake of smoking at more than a year. Updated reviews also suggested that naltrexone, selective serotonin re-uptake inhibitors and St John's wort do not have a significant effect on long-term smoking cessation. CONCLUSIONS Cochrane systematic review evidence from 2013 suggests that adding mood management to behavioural support may improve cessation outcomes in smokers with current or past depression and strengthens evidence for previous conclusions, including the safety of varenicline and bupropion and the benefits of behavioural support for smoking cessation in pregnancy.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Li IC, Lee SYD, Chen CY, Jeng YQ, Chen YC. Facilitators and barriers to effective smoking cessation: counselling services for inpatients from nurse-counsellors' perspectives--a qualitative study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4782-98. [PMID: 24806190 PMCID: PMC4053899 DOI: 10.3390/ijerph110504782] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 11/30/2022]
Abstract
Tobacco use has reached epidemic levels around the World, resulting in a world-wide increase in tobacco-related deaths and disabilities. Hospitalization presents an opportunity for nurses to encourage inpatients to quit smoking. This qualitative descriptive study was aimed to explore nurse-counsellors' perspectives of facilitators and barriers in the implementation of effective smoking cessation counselling services for inpatients. In-depth interviews were conducted with 16 nurses who were qualified smoking cessation counsellors and who were recruited from eleven health promotion hospitals that were smoke-free and located in the Greater Taipei City Area. Data were collected from May 2012 to October 2012, and then analysed using content analysis based on the grounded theory approach. From nurse-counsellors' perspectives, an effective smoking cessation program should be patient-centred and provide a supportive environment. Another finding is that effective smoking cessation counselling involves encouraging patients to modify their lifestyles. Time constraints and inadequate resources are barriers that inhibit the effectiveness of smoking cessation counselling programs in acute-care hospitals. We suggest that hospitals should set up a smoking counselling follow-up program, including funds, facilities, and trained personnel to deliver counselling services by telephone, and build a network with community smoking cessation resources.
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Affiliation(s)
- I-Chuan Li
- Institute of Clinical and Community Health Nursing, School of Nursing, National Yang-Ming University, No. 155, Section 2, Li-Nong St. Beitou, Taipei 11221, Taiwan.
| | - Shoou-Yih D Lee
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, 1420 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Chiu-Yen Chen
- Department of Nursing, School of Nursing, National Yang-Ming University, No. 155, Section 2, Li-Nong St. Beitou, Taipei 11221, Taiwan.
| | - Yu-Qian Jeng
- Jhubei City Health Center, Public Health Bureau, HsinChu County Government, No. 89, Guangming 2nd St., Zhubei City, Hsinchu County 30251, Taiwan.
| | - Yu-Chi Chen
- Department of Nursing, School of Nursing, National Yang-Ming University, No. 155, Section 2, Li-Nong St. Beitou, Taipei 11221, Taiwan.
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Sarna LP, Bialous SA, Kraliková E, Kmetova A, Felbrová V, Kulovaná S, Malá K, Roubicková E, Wells MJ, Brook JK. Impact of a smoking cessation educational program on nurses' interventions. J Nurs Scholarsh 2014; 46:314-21. [PMID: 24758571 DOI: 10.1111/jnu.12086] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate a brief educational program about smoking cessation on the frequency of nurses' interventions with smokers, and impact of nurses' smoking status on outcomes. DESIGN Prospective, single group design with prestudy and 3 months post-study data. METHODS Nurses in the Czech Republic attended hospital-based 1-hr educational programs about helping smokers quit. They completed surveys about the frequency (i.e., always, usually, sometimes, rarely, never) of their smoking cessation interventions with patients using the five A's framework (i.e., ask, advise, assess, assist, arrange), and their attitudes prior to and 3 months after the course. Demographic data included smoking status. FINDINGS Among the 98 nurses with prestudy and post-study data, all were female, mean age was 43 years, 33% were current smokers, and 64% worked in a medical or surgical or oncology settings. At 3 months, compared to baseline, significantly (p < .05) more nurses assessed patients' interest in quitting, assisted with quit attempts, and recommended the use of the quitline for cessation. At 3 months after the program, nurses who smoked were less likely to ask about smoking status (odds ratio [OR] = 4.24, 95% confidence interval [CI; 1.71, 10.53]), advise smokers to quit (OR = 3.03, 95% CI [1.24,7.45]), and refer patients to a quitline (OR = 2.92, 95% CI [0.99, 8.63]) compared to nonsmokers, despite no differences in delivery of interventions at baseline. CONCLUSIONS Three months after attendance at an educational program focused on the nurses' role in supporting smoking cessation efforts, more nurses engaged in interventions to help smokers quit. However, the program was less effective for nurses who smoked. CLINICAL RELEVANCE This program demonstrated promise in building capacity among Czech nurses to assist with smoking cessation, but nurses' smoking poses a challenge.
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Affiliation(s)
- Linda P Sarna
- Gamma Tau Chapter, Professor and Lulu Wolf Hassenplug Endowed Chair, School of Nursing, University of California, Los Angeles, CA
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Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [PMID: 24671929 DOI: 10.1002/14651858.cd002294.pub4.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. OBJECTIVES The objectives of this review are to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register in January 2014. SELECTION CRITERIA Randomized controlled trials that recruited people who smoked prior to surgery, offered a smoking cessation intervention, and measured preoperative and long-term abstinence from smoking or the incidence of postoperative complications or both outcomes. DATA COLLECTION AND ANALYSIS The review authors independently assessed studies to determine eligibility, and discussed the results between them. MAIN RESULTS Thirteen trials enrolling 2010 participants met the inclusion criteria. One trial did not report cessation as an outcome. Seven reported some measure of postoperative morbidity. Most studies were judged to be at low risk of bias but the overall quality of evidence was moderate due to the small number of studies contributing to each comparison.Ten trials evaluated the effect of behavioural support on cessation at the time of surgery; nicotine replacement therapy (NRT) was offered or recommended to some or all participants in eight of these. Two trials initiated multisession face-to-face counselling at least four weeks before surgery and were classified as intensive interventions, whilst seven used a brief intervention. One further study provided an intensive intervention to both groups, with the intervention group additionally receiving a computer-based scheduled reduced smoking intervention. One placebo-controlled trial examined the effect of varenicline administered one week preoperatively followed by 11 weeks postoperative treatment, and one placebo-controlled trial examined the effect of nicotine lozenges from the night before surgery as an adjunct to brief counselling at the preoperative evaluation. There was evidence of heterogeneity between the effects of trials using intensive and brief interventions, so we pooled these separately. An effect on cessation at the time of surgery was apparent in both subgroups, but the effect was larger for intensive intervention (pooled risk ratio (RR) 10.76; 95% confidence interval (CI) 4.55 to 25.46, two trials, 210 participants) than for brief interventions (RR 1.30; 95% CI 1.16 to 1.46, 7 trials, 1141 participants). A single trial did not show evidence of benefit of a scheduled reduced smoking intervention. Neither nicotine lozenges nor varenicline were shown to increase cessation at the time of surgery but both had wide confidence intervals (RR 1.34; 95% CI 0.86 to 2.10 (1 trial, 46 participants) and RR 1.49; 95% CI 0.98 to 2.26 (1 trial, 286 participants) respectively). Four of these trials evaluated long-term smoking cessation and only the intensive intervention retained a significant effect (RR 2.96; 95% CI 1.57 to 5.55, 2 trials, 209 participants), whilst there was no evidence of a long-term effect following a brief intervention (RR 1.09; 95% CI 0.68 to 1.75, 2 trials, 341 participants). The trial of varenicline did show a significant effect on long-term smoking cessation (RR 1.45; 95% CI 1.01 to 2.07, 1 trial, 286 participants).Seven trials examined the effect of smoking intervention on postoperative complications. As with smoking outcomes, there was evidence of heterogeneity between intensive and brief behavioural interventions. In subgroup analyses there was a significant effect of intensive intervention on any complications (RR 0.42; 95% CI 0.27 to 0.65, 2 trials, 210 participants) and on wound complications (RR 0.31; 95% CI 0.16 to 0.62, 2 trials, 210 participants). For brief interventions, where the impact on smoking had been smaller, there was no evidence of a reduction in complications (RR 0.92; 95% CI 0.72 to 1.19, 4 trials, 493 participants) for any complication (RR 0.99; 95% CI 0.70 to 1.40, 3 trials, 325 participants) for wound complications. The trial of varenicline did not detect an effect on postoperative complications (RR 0.94; 95% CI 0.52 to 1.72, 1 trial, 286 participants). AUTHORS' CONCLUSIONS There is evidence that preoperative smoking interventions providing behavioural support and offering NRT increase short-term smoking cessation and may reduce postoperative morbidity. One trial of varenicline begun shortly before surgery has shown a benefit on long-term cessation but did not detect an effect on early abstinence or on postoperative complications. The optimal preoperative intervention intensity remains unknown. Based on indirect comparisons and evidence from two small trials, interventions that begin four to eight weeks before surgery, include weekly counselling and use NRT are more likely to have an impact on complications and on long-term smoking cessation.
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Affiliation(s)
- Thordis Thomsen
- Abdominal Centre, 3133, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark, 2100
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86
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Abstract
BACKGROUND Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. OBJECTIVES The objectives of this review are to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register in January 2014. SELECTION CRITERIA Randomized controlled trials that recruited people who smoked prior to surgery, offered a smoking cessation intervention, and measured preoperative and long-term abstinence from smoking or the incidence of postoperative complications or both outcomes. DATA COLLECTION AND ANALYSIS The review authors independently assessed studies to determine eligibility, and discussed the results between them. MAIN RESULTS Thirteen trials enrolling 2010 participants met the inclusion criteria. One trial did not report cessation as an outcome. Seven reported some measure of postoperative morbidity. Most studies were judged to be at low risk of bias but the overall quality of evidence was moderate due to the small number of studies contributing to each comparison.Ten trials evaluated the effect of behavioural support on cessation at the time of surgery; nicotine replacement therapy (NRT) was offered or recommended to some or all participants in eight of these. Two trials initiated multisession face-to-face counselling at least four weeks before surgery and were classified as intensive interventions, whilst seven used a brief intervention. One further study provided an intensive intervention to both groups, with the intervention group additionally receiving a computer-based scheduled reduced smoking intervention. One placebo-controlled trial examined the effect of varenicline administered one week preoperatively followed by 11 weeks postoperative treatment, and one placebo-controlled trial examined the effect of nicotine lozenges from the night before surgery as an adjunct to brief counselling at the preoperative evaluation. There was evidence of heterogeneity between the effects of trials using intensive and brief interventions, so we pooled these separately. An effect on cessation at the time of surgery was apparent in both subgroups, but the effect was larger for intensive intervention (pooled risk ratio (RR) 10.76; 95% confidence interval (CI) 4.55 to 25.46, two trials, 210 participants) than for brief interventions (RR 1.30; 95% CI 1.16 to 1.46, 7 trials, 1141 participants). A single trial did not show evidence of benefit of a scheduled reduced smoking intervention. Neither nicotine lozenges nor varenicline were shown to increase cessation at the time of surgery but both had wide confidence intervals (RR 1.34; 95% CI 0.86 to 2.10 (1 trial, 46 participants) and RR 1.49; 95% CI 0.98 to 2.26 (1 trial, 286 participants) respectively). Four of these trials evaluated long-term smoking cessation and only the intensive intervention retained a significant effect (RR 2.96; 95% CI 1.57 to 5.55, 2 trials, 209 participants), whilst there was no evidence of a long-term effect following a brief intervention (RR 1.09; 95% CI 0.68 to 1.75, 2 trials, 341 participants). The trial of varenicline did show a significant effect on long-term smoking cessation (RR 1.45; 95% CI 1.01 to 2.07, 1 trial, 286 participants).Seven trials examined the effect of smoking intervention on postoperative complications. As with smoking outcomes, there was evidence of heterogeneity between intensive and brief behavioural interventions. In subgroup analyses there was a significant effect of intensive intervention on any complications (RR 0.42; 95% CI 0.27 to 0.65, 2 trials, 210 participants) and on wound complications (RR 0.31; 95% CI 0.16 to 0.62, 2 trials, 210 participants). For brief interventions, where the impact on smoking had been smaller, there was no evidence of a reduction in complications (RR 0.92; 95% CI 0.72 to 1.19, 4 trials, 493 participants) for any complication (RR 0.99; 95% CI 0.70 to 1.40, 3 trials, 325 participants) for wound complications. The trial of varenicline did not detect an effect on postoperative complications (RR 0.94; 95% CI 0.52 to 1.72, 1 trial, 286 participants). AUTHORS' CONCLUSIONS There is evidence that preoperative smoking interventions providing behavioural support and offering NRT increase short-term smoking cessation and may reduce postoperative morbidity. One trial of varenicline begun shortly before surgery has shown a benefit on long-term cessation but did not detect an effect on early abstinence or on postoperative complications. The optimal preoperative intervention intensity remains unknown. Based on indirect comparisons and evidence from two small trials, interventions that begin four to eight weeks before surgery, include weekly counselling and use NRT are more likely to have an impact on complications and on long-term smoking cessation.
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Affiliation(s)
- Thordis Thomsen
- RigshospitaletAbdominal Centre, 3133Blegdamsvej 9CopenhagenDenmark2100
- Lund UniversityClinical Health Promotion Centre, Faculty of MedicineLundSweden
| | - Nete Villebro
- Danish Nurses OrganizationSankt Annæ plads 30Copenhagen KDenmark12503
| | - Ann Merete Møller
- University of Copenhagen Herlev HospitalThe Cochrane Anaesthesia Review Group, Rigshospitalet & Department of AnaesthesiologyHerlev RingvejHerlevDenmark2730
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87
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Bains M, Britton J, Marsh J, Jayes L, Murray RL. Patients' and healthcare professionals' views on a specialist smoking cessation service delivered in a United Kingdom hospital: a qualitative study. Tob Induc Dis 2014; 12:2. [PMID: 24472521 PMCID: PMC3909354 DOI: 10.1186/1617-9625-12-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/27/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Hospital admission provides a powerful opportunity to promote smoking cessation. We explored patients' and healthcare professionals' (HCP) views of a specialist smoking cessation service comprising systematic smoking ascertainment, default provision of pharmacotherapy and behavioural counselling at the bedside, and post-discharge follow-up, in a clinical trial in a United Kingdom teaching hospital. METHODS Semi-structured interviews with 30 patients who were offered the intervention, and 27 HCPs working on intervention wards, were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS The shock of being admitted, and awareness that smoking may have contributed to the need for hospital admission, caused many patients to reassess their quit intentions. Most patients felt the service was too good an opportunity to pass up, because having long-term support and progress monitored was more likely to result in abstinence than trying alone. Had they not been approached, many patients reported that they would have attempted to quit alone, though some would have been discouraged from doing so by pharmacotherapy costs. Service delivery by a specialist advisor was favoured by patients and HCPs, largely because HCPs lacked time and expertise to intervene. HCPs reported that in usual practice, discussions about smoking were usually limited to ascertainment of smoking status. Timing of service delivery and improved co-ordination between service staff and inpatient ward staff were matters to address. CONCLUSIONS A hospital-based specialist smoking cessation service designed to identify smokers and initiate cessation support at the bedside was deemed appropriate by patients and HCPs. TRIAL REGISTRATION Trial registration: ISRCTN25441641.
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Affiliation(s)
- Manpreet Bains
- UK Centre for Tobacco and Alcohol Studies and Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1 PB, UK
| | - John Britton
- UK Centre for Tobacco and Alcohol Studies and Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1 PB, UK
| | - John Marsh
- UK Centre for Tobacco and Alcohol Studies and Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1 PB, UK
| | - Leah Jayes
- UK Centre for Tobacco and Alcohol Studies and Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1 PB, UK
| | - Rachael L Murray
- UK Centre for Tobacco and Alcohol Studies and Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1 PB, UK
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