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Orthopaedic trauma patients and smoking: Knowledge deficits and interest in quitting. Injury 2016; 47:1206-11. [PMID: 27090096 DOI: 10.1016/j.injury.2016.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/09/2016] [Accepted: 03/14/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Smoking is associated with increased complications in fracture care. Smoking cessation has a positive impact on outcomes. It is unknown whether orthopaedic trauma patients understand the ill effects of smoking on fracture care and whether knowledge can improve cessation interest. We hypothesized that (1) smokers less fully understand the negative effects of smoking than do nonsmokers, (2) an increased proportion of orthopaedic trauma patients are further in the process of change to quit smoking, (3) increased knowledge predicts increased readiness to quit, and (4) minimal education through a survey can improve interest in smoking cessation. METHODS Single-centre cross-sectional cohort survey study. Patients were approached consecutively for participation. Patients 18 years or older with a new fracture in our clinic for follow-up were eligible. Smokers and nonsmokers were included and surveyed regarding demographics. Smokers were asked questions about fractures and general knowledge questions regarding the effects of smoking on health. Smokers' interest in smoking cessation was assessed with direct questions, and transtheoretical model stage of change was queried before and after survey administration. RESULTS One hundred twelve patients participated (44 smokers, 68 nonsmokers; 75 male patients, 37 female patients). Forty-eight percent of smokers stated that the fracture made them more likely to quit. Smokers answered more questions incorrectly than did nonsmokers (p=0.003). An increased percentage of smokers were in favourable stages of change compared with a population-based tobacco survey (68% versus 54%, p=0.008). Survey administration increased interest in quitting in 48%, and 11% modified their stage of change towards quitting. Smokers scoring higher on knowledge questions had more than 2-fold increased odds of being in a favourable stage of change (p=0.013; odds ratio, 2.13; 95% confidence interval, 1.744-3.855). CONCLUSIONS Compared with nonsmokers, smokers less fully understand the negative effects of smoking on fracture care and general health. A large proportion of orthopaedic trauma patients who smoke are interested in smoking cessation and are possibly further along the pathway to change than expected. Brief education through a survey can increase interest in quitting. Formal education intervention may improve cessation rates and fracture outcomes.
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Finkelstein J, Cha EM. Using a Mobile App to Promote Smoking Cessation in Hospitalized Patients. JMIR Mhealth Uhealth 2016; 4:e59. [PMID: 27154792 PMCID: PMC4875494 DOI: 10.2196/mhealth.5149] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 03/13/2016] [Accepted: 03/30/2016] [Indexed: 11/16/2022] Open
Abstract
Background The potential of interactive health education for preventive health applications has been widely demonstrated. However, use of mobile apps to promote smoking cessation in hospitalized patients has not been systematically assessed. Objective This study was conducted to assess the feasibility of using a mobile app for the hazards of smoking education delivered via touch screen tablets to hospitalized smokers. Methods Fifty-five consecutive hospitalized smokers were recruited. Patient sociodemographics and smoking history was collected at baseline. The impact of the mobile app was assessed by measuring cognitive and behavioral factors shown to promote smoking cessation before and after the mobile app use including hazards of smoking knowledge score (KS), smoking attitudes, and stages of change. Results After the mobile app use, mean KS increased from 27(3) to 31(3) (P<0.0001). Proportion of patients who felt they “cannot quit smoking” reduced from 36% (20/55) to 18% (10/55) (P<0.03). Overall, 13% (7/55) of patients moved toward a more advanced stage of change with the proportion of patients in the preparation stage increased from 40% (22/55) to 51% (28/55). Multivariate regression analysis demonstrated that knowledge gains and mobile app acceptance did not depend on age, gender, race, computer skills, income, or education level. The main factors affecting knowledge gain were initial knowledge level (P<0.02), employment status (P<0.05), and high app acceptance (P<0.01). Knowledge gain was the main predictor of more favorable attitudes toward the mobile app (odds ratio (OR)=4.8; 95% confidence interval (CI) (1.1, 20.0)). Attitudinal surveys and qualitative interviews identified high acceptance of the mobile app by hospitalized smokers. Over 92% (51/55) of the study participants recommended the app for use by other hospitalized smokers and 98% (54/55) of the patients were willing to use such an app in the future. Conclusions Our results suggest that a mobile app promoting smoking cessation is well accepted by hospitalized smokers. The app can be used for interactive patient education and counseling during hospital stays. Development and evaluation of mobile apps engaging patients in their care during hospital stays is warranted.
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Affiliation(s)
- Joseph Finkelstein
- Columbia University, Department of Biomedical Informatics, New York, NY, United States.
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Catley D, Goggin K, Harris KJ, Richter KP, Williams K, Patten C, Resnicow K, Ellerbeck EF, Bradley-Ewing A, Lee HS, Moreno JL, Grobe JE. A Randomized Trial of Motivational Interviewing: Cessation Induction Among Smokers With Low Desire to Quit. Am J Prev Med 2016; 50:573-583. [PMID: 26711164 PMCID: PMC4841713 DOI: 10.1016/j.amepre.2015.10.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Despite limitations in evidence, the current Clinical Practice Guideline advocates Motivational Interviewing for smokers not ready to quit. This study evaluated the efficacy of Motivational Interviewing for inducing cessation-related behaviors among smokers with low motivation to quit. DESIGN Randomized clinical trial. SETTING/PARTICIPANTS Two-hundred fifty-five daily smokers reporting low desire to quit smoking were recruited from an urban community during 2010-2011 and randomly assigned to Motivational Interviewing, health education, or brief advice using a 2:2:1 allocation. Data were analyzed from 2012 to 2014. INTERVENTION Four sessions of Motivational Interviewing utilized a patient-centered communication style that explored patients' own reasons for change. Four sessions of health education provided education related to smoking cessation while excluding elements characteristic of Motivational Interviewing. A single session of brief advice consisted of brief, personalized advice to quit. MAIN OUTCOMES MEASURES Self-reported quit attempts; smoking abstinence (biochemically verified); use of cessation pharmacotherapies; motivation; and confidence to quit were assessed at baseline and 3- and 6-month follow-ups. RESULTS Unexpectedly, no significant differences emerged between groups in the proportion who made a quit attempt by 6-month follow-up (Motivational Interviewing, 52.0%; health education, 60.8%; brief advice, 45.1%; p=0.157). Health education had significantly higher biochemically verified abstinence rates at 6 months (7.8%) than brief advice (0.0%) (8% risk difference, 95% CI=3%, 13%, p=0.003), with the Motivational Interviewing group falling in between (2.9% abstinent, 3% risk difference, 95% CI=0%, 6%, p=0.079). Both Motivational Interviewing and health education groups showed greater increases in cessation medication use, motivation, and confidence to quit relative to brief advice (all p<0.05), and health education showed greater increases in motivation relative to Motivational Interviewing (Cohen's d=0.36, 95% CI=0.12, 0.60). CONCLUSIONS Although Motivational Interviewing was generally more efficacious than brief advice in inducing cessation behaviors, health education appeared the most efficacious. These results highlight the need to identify the contexts in which Motivational Interviewing may be most efficacious and question recommendations to use Motivational Interviewing rather than other less complex cessation induction interventions. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01188018.
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Affiliation(s)
- Delwyn Catley
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri.
| | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri; Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri
| | - Kari Jo Harris
- School of Public and Community Health Sciences, The University of Montana, Missoula, Montana
| | - Kimber P Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Missouri
| | - Karen Williams
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Edward F Ellerbeck
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Missouri
| | - Andrea Bradley-Ewing
- Division of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Hyoung S Lee
- School of Interdisciplinary Arts and Sciences, University of Washington Tacoma, Tacoma, Washington
| | - Jose L Moreno
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
| | - James E Grobe
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
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Huang HY, Lin YS, Chuang YC, Lin WH, Kuo LY, Chen JC, Hsu CL, Chen BY, Tsai HY, Cheng FH, Tsai MW. Application of the Transtheoretical Model to Exercise Behavior and Physical Activity in Patients after Open Heart Surgery. ACTA CARDIOLOGICA SINICA 2016; 31:202-8. [PMID: 27122871 DOI: 10.6515/acs20150204a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess exercise behavior and physical activity levels after open heart surgery. METHODS This prospective cohort study included 130 patients (70.8% male, aged 61.0 ± 12.2 years, 53.8% coronary bypass grafting) who underwent open heart surgery. The exercise behavior and physical activity of these patients were assessed at the 3- and 6-month follow-up appointments. Additional interviews were also conducted to further assess exercise behavior. Physical activity duration and metabolic equivalents were calculated from self-reported questionnaire responses. Moreover, possible related demographic factors, clinical features, participation in cardiac rehabilitation programs, and physical activity levels were additionally evaluated. RESULTS Six months after hospital discharge, most patients were in the action (39.2%) and maintenance (37.7%) stages. Other subjects were in the precontemplation (11.5%), contemplation (5.4%), and preparation (6.2%) stages. The average physical activity level was 332.6 ± 377.1 min/week and 1198.1 ± 1396.9 KJ/week. Subjects in the action and maintenance stages exercised an average of 399.4 ± 397.6 min/week, significantly longer than those in other stages (116.2 ± 176.2 min/week, p = 0.02). Subjects that participated in outpatient cardiac rehabilitation programs after discharge may have the better exercise habit. Gender had no significant effect on exercise behavior 6 months after hospital discharge. CONCLUSIONS Most subjects following open heart surgery may maintain regular exercise behavior at 6 months after hospital discharge. Physical activity levels sufficient for cardiac health were achieved by subjects in the active and maintenance stages. Outpatient cardiac rehabilitation programs are valuable for encouraging exercise behavior after heart surgery. KEY WORDS Exercise behavior; Open heart surgery; Physical activity; Transtheoretical model.
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Klingaman EA, Hoerster KD, Aakre JM, Viverito KM, Medoff DR, Goldberg RW. Veterans with PTSD report more weight loss barriers than Veterans with no mental health disorders. Gen Hosp Psychiatry 2016; 39:1-7. [PMID: 26719103 DOI: 10.1016/j.genhosppsych.2015.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/07/2015] [Accepted: 11/12/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This study characterized and compared Veterans of the United States Armed Forces with posttraumatic stress disorder (PTSD) to Veterans with no mental health disorders on self-reported measures of factors that influence success in weight management programs. METHOD We examined the relation of PTSD diagnosis with weight loss plan, reasons for overweight/obesity and barriers to dieting and physical exercise among 171,884 Veterans. Statistically significant variables in chi-square tests (P<.05) with at least a small effect size were then compared via multivariate logistic regression analyses. RESULTS Both groups reported high ratings of importance and confidence regarding changing weight loss behaviors and were preparing or actively engaging in efforts to manage their weight. Compared to Veterans without mental health disorders, more Veterans with PTSD endorsed 27 of the 28 barriers to changing eating and physical habits. CONCLUSIONS The results of this study help to explain the lower rates of success of Veterans with PTSD in weight loss programs. Results suggest that a comprehensive, integrated approach to promoting weight loss in Veterans with PTSD is needed.
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Affiliation(s)
- Elizabeth A Klingaman
- U.S. Department of Veterans Affairs Capitol Healthcare Network Mental Illness Research, Education and Clinical Center, 10 North Greene Street, Annex Suite 720, Baltimore, MD 21201, USA; University of Maryland School of Medicine Department of Psychiatry, 737 West Lombard Street, Baltimore, MD 21201, USA.
| | - Katherine D Hoerster
- Mental Health Service, VA Puget Sound Healthcare System, Seattle Division, 1660 South Columbian Way (S-116), Seattle, WA 98108, USA; University of Washington Department of Psychiatry and Behavioral Sciences, 1959 Northeast Pacific Street, Box 356560, Room BB1644, Seattle, WA 98195, USA.
| | - Jennifer M Aakre
- U.S. Department of Veterans Affairs Capitol Healthcare Network Mental Illness Research, Education and Clinical Center, 10 North Greene Street, Annex Suite 720, Baltimore, MD 21201, USA; University of Maryland School of Medicine Department of Psychiatry, 737 West Lombard Street, Baltimore, MD 21201, USA.
| | - Kristen M Viverito
- Central Arkansas Veterans Healthcare System, Health Services Research and Development Service, Center for Mental Healthcare and Outcomes Research, North Little Rock, AR 72114, USA; Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham, #554, Little Rock, AR 72205, USA.
| | - Deborah R Medoff
- University of Maryland School of Medicine Department of Psychiatry, 737 West Lombard Street, Baltimore, MD 21201, USA; U.S. Department of Veterans Affairs Capitol Healthcare Network Mental Illness Research, Education and Clinical Center, 10 North Greene Street, Annex Suite 720, Baltimore, MD 21201, USA.
| | - Richard W Goldberg
- U.S. Department of Veterans Affairs Capitol Healthcare Network Mental Illness Research, Education and Clinical Center, 10 North Greene Street, Annex Suite 720, Baltimore, MD 21201, USA; University of Maryland School of Medicine Department of Psychiatry, 737 West Lombard Street, Baltimore, MD 21201, USA.
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Battaglia C, Peterson J, Whitfield E, Min SJ, Benson SL, Maddox TM, Prochazka AV. Integrating Motivational Interviewing Into a Home Telehealth Program for Veterans With Posttraumatic Stress Disorder Who Smoke: A Randomized Controlled Trial. J Clin Psychol 2016; 72:194-206. [DOI: 10.1002/jclp.22252] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | | | | | | | | | - Thomas M. Maddox
- Eastern Colorado Health Care System
- University of Colorado Denver
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Papadakis S, Tulloch HE, Gharib M, Pipe AL. Profile of tobacco users identified in primary care practice and predictors of readiness to quit: a cross-sectional survey. CMAJ Open 2016; 4:E41-7. [PMID: 27280113 PMCID: PMC4866932 DOI: 10.9778/cmajo.20150055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The aim of this study was to document the prevalence of tobacco use and describe the characteristics of tobacco users identified in primary care practices. METHODS We conducted a cross-sectional survey in 49 primary care practices in the province of Ontario. Consecutive patients were screened for smoking status at the time of their clinic appointment. Patients reporting current tobacco use completed a survey, which documented sociodemographic and smoking-related characteristics. Multilevel modelling was used to examine predictors of readiness to quit smoking and the presence of anxiety and/or depression. RESULTS A total of 56 592 patients were screened, and 5245 tobacco users participated in the survey. Prevalence of tobacco use was 18.2% and varied significantly across practices (range 12.4%-36.1%). Of the respondents, 46.3% reported current anxiety and/or depression, and 61.3% reported smoking within the first 30 minutes of waking. A total of 41.1% of respondents reported they were ready to quit smoking in the next 6 months, and 30.1% reported readiness to quit in the next 30 days. Readiness to quit was positively associated with higher self-efficacy, male sex, presence of chronic obstructive pulmonary disease and more years of tobacco use. The presence of anxiety and/or depression was associated with lower cessation self-efficacy and time to first cigarette within 30 minutes of waking, but did not predict readiness to quit. INTERPRETATION Tobacco users identified in primary care practices reported high rates of nicotine dependence and anxiety and/or depression, but also high rates of readiness to quit. Study findings support the need to tailor interventions to address the needs of tobacco users identified in primary care settings.
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Affiliation(s)
- Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont
| | - Heather E Tulloch
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont
| | - Marie Gharib
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont
| | - Andrew L Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont
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Park ER, Gareen IF, Japuntich S, Lennes I, Hyland K, DeMello S, Sicks JD, Rigotti NA. Primary Care Provider-Delivered Smoking Cessation Interventions and Smoking Cessation Among Participants in the National Lung Screening Trial. JAMA Intern Med 2015; 175:1509-16. [PMID: 26076313 PMCID: PMC5089370 DOI: 10.1001/jamainternmed.2015.2391] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE The National Lung Screening Trial (NLST) found a reduction in lung cancer mortality among participants screened with low-dose computed tomography vs chest radiography. In February 2015, Medicare announced its decision to cover annual lung screening for patients with a significant smoking history. These guidelines promote smoking cessation treatment as an adjunct to screening, but the frequency and effectiveness of clinician-delivered smoking cessation interventions delivered after lung screening are unknown. OBJECTIVE To determine the association between the reported clinician-delivered 5As (ask, advise, assess, assist [talk about quitting or recommend stop-smoking medications or recommend counseling], and arrange follow-up) after lung screening and smoking behavior changes. DESIGN, SETTING, AND PARTICIPANTS A matched case-control study (cases were quitters and controls were continued smokers) of 3336 NLST participants who were smokers at enrollment examined participants' rates and patterns of 5A delivery after a lung screen and reported smoking cessation behaviors. MAIN OUTCOMES AND MEASURES Prevalence of the clinician-delivered 5As and associated smoking cessation after lung screening. RESULTS Delivery of the 5As 1 year after screening were as follows: ask, 77.2%; advise, 75.6%; assess, 63.4%; assist, 56.4%; and arrange follow-up, 10.4%. Receipt of ask, advise, and assess was not significantly associated with quitting in multivariate models that adjusted for sociodemographic characteristics, medical history, screening results, nicotine dependence, and motivation to quit. Assist was associated with a 40% increase in the odds of quitting (odds ratio, 1.40; 95% CI, 1.21-1.63), and arrange was associated with a 46% increase in the odds of quitting (odds ratio, 1.46; 95% CI, 1.19-1.79). CONCLUSIONS AND RELEVANCE Assist and arrange follow-up delivered by primary care providers to smokers who were participating in the NLST were associated with increased quitting; less intensive interventions (ask, advise, and assess) were not. However, rates of assist and arrange follow-up were relatively low. Our findings confirm the need for and benefit of clinicians taking more active intervention steps in helping patients who undergo screening to quit smoking.
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Affiliation(s)
- Elyse R Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston2Mongan Institute for Health Policy, Massachusetts General Hospital, Boston
| | - Ilana F Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island4Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Sandra Japuntich
- National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Inga Lennes
- Massachusetts General Hospital Cancer Center, Boston
| | - Kelly Hyland
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston2Mongan Institute for Health Policy, Massachusetts General Hospital, Boston
| | - Sarah DeMello
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - JoRean D Sicks
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston7Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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Cunningham JA, Kushnir V, McCambridge J. The Impact of Asking About Interest in Free Nicotine Patches on Smoker's Stated Intent to Change: Real Effect or Artefact of Question Ordering? Nicotine Tob Res 2015; 18:1215-7. [PMID: 26259987 DOI: 10.1093/ntr/ntv173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/03/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Stage of change questions are often included on general population surveys to assess the proportion of current smokers intending to quit. The current study reported on a methodological experiment to establish whether participant's self-reported stage of change can be influenced by asking about interest in free nicotine patches immediately prior to asking about intent to change. METHODS As part of an ongoing random digit dialing survey, a randomized half of participants were asked if they would be interested in receiving nicotine patches to help them quit smoking prior to being asked whether they intended to quit smoking in the next 6 months and 30 days. RESULTS Participants who were first asked about interest in free nicotine patches were more likely to rate themselves as in preparation for change (asked first = 33%; not asked first = 19%), and less likely to rate themselves as in the precontemplation stage of change (asked first = 34%; not asked first = 47%), compared with participants who were not asked about their interest in free nicotine patches prior to being asked about their stage of change (P < .001). CONCLUSIONS There are several possible explanations of the results. It is possible that offers of free nicotine patches increases smokers intentions to quit, at least temporarily. Alternatively, smokers being asked about interest in free nicotine patches may expect that the researchers would like to hear about people intending to quit, and respond accordingly.
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Affiliation(s)
- John A Cunningham
- National Institute for Mental Health Research, Australian National University, Canberra, Australia; Social, Prevention and Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada;
| | - Vladyslav Kushnir
- Social, Prevention and Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmaceutical Sciences, University of Toronto, Toronto, ON, Canada
| | - Jim McCambridge
- Department of Health Sciences, University of York, York, United Kingdom
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Daoud N, Hayek S, Sheikh Muhammad A, Abu-Saad K, Osman A, Thrasher JF, Kalter-Leibovici O. Stages of change of the readiness to quit smoking among a random sample of minority Arab male smokers in Israel. BMC Public Health 2015; 15:672. [PMID: 26178347 PMCID: PMC4607270 DOI: 10.1186/s12889-015-1950-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 06/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite advanced smoking prevention and cessation policies in many countries, the prevalence of cigarette smoking among indigenous and some ethnic minorities continues to be high. This study examined the stages of change (SOC) of the readiness to quit smoking among Arab men in Israel shortly after new regulations of free-of-charge smoking cessation workshops and subsidized medications were introduced through primary health care clinics. METHODS We conducted a countrywide study in Israel between 2012-2013. Participants, 735 current smokers; 18-64 years old; were recruited from a stratified random sample and interviewed face-to-face using a structured questionnaire in Arabic. We used ordered regression to examine the contribution of socio-economic position (SEP), health status, psychosocial attributes, smoking-related factors, and physician advice to the SOC of the readiness to quit smoking (pre-contemplation, contemplation and preparation). RESULTS Of the current smokers, 61.8% were at the pre-contemplation stage, 23.8% were at the contemplation stage, and only 14.4% were at the preparation stage. In the multinomial analysis, factors significantly (P < 0.05) contributing to contemplation stage compared to pre-contemplation stage included [odds ratio (OR), 95% confidence interval (CI)]: chronic morbidity [0.52, (0.31-0.88)], social support [1.35, (1.07-1.70)], duration of smoking for 11-21 years [1.94, (1.07-3.50)], three or more previous attempts to quit [2.27, (1.26-4.01)], knowledge about smoking hazards [1.75, (1.29-2.35)], positive attitudes toward smoking prevention [1.44, (1.14-1.82)], and physician advice to quit smoking [1.88, (1.19-2.97)]. The factors significantly (P < 0.05) contributing to preparation stage compared to pre-contemplation stage were [OR, (95 % CI)]: chronic morbidity [0.36, (0.20-0.67)], anxiety [1.07, (1.01-1.13)], social support [1.34, (1.01-1.78)], duration of smoking 5 years or less [2.93, (1.14-7.52)], three or more previous attempts to quit [3.16, (1.60-6.26)], knowledge about smoking hazards [1.57, (1.10-2.21)], and positive attitudes toward smoking prevention [1.34, (1.00-1.82)]. CONCLUSIONS Most Arab men who currently smoke are in the pre-contemplation stage, indicating low readiness to quit smoking. New policies of free-of-charge smoking-cessation group sessions and subsidized medications introduced through primary health care clinics in Israel may be less effective among Arab men. For these policies to promote cessation more successfully, tailored interventions and campaigns may be needed to increase the readiness to quit smoking in this population, especially for those at the pre-contemplation stage.
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Affiliation(s)
- Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, 84015, Israel.
| | - Samah Hayek
- School of Public Health. University of Haifa, Haifa, Israel.
| | - Ahmad Sheikh Muhammad
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva, 84015, Israel.
| | - Kathleen Abu-Saad
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, 52621, Israel.
| | - Amira Osman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA.
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA.
| | - Ofra Kalter-Leibovici
- Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, 52621, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Matlow RB, DePrince AP. The Impact of Appraisals and Context on Readiness to Leave a Relationship Following Intimate Partner Abuse. Violence Against Women 2015; 21:1043-64. [PMID: 26077326 DOI: 10.1177/1077801215590668] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current longitudinal study examined the relative impact of symptoms and appraisals as well as contextual and demographic factors on women's subsequent readiness to leave a relationship following intimate partner abuse. An ethnically diverse sample of women (N = 177) completed measures assessing posttrauma appraisals, symptoms, dependence on the perpetrator, and abuse characteristics. One year later, women reported on their readiness to leave the relationship. Regression analyses revealed that readiness to leave was (a) positively predicted by fear appraisals, (b) negatively predicted by shame appraisals, and (c) significantly associated with additional contextual factors (i.e., dependence on the perpetrator, stalking behaviors).
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Gantiva C, Guerra P, Vila J. From appetitive to aversive: motivational interviewing reverses the modulation of the startle reflex by tobacco cues in smokers not ready to quit. Behav Res Ther 2015; 66:43-8. [PMID: 25698163 DOI: 10.1016/j.brat.2015.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 11/25/2022]
Abstract
Motivational Interviewing (MI) is a treatment method that has proven effective for increasing motivation to change and decreasing the consumption of different drugs. However, the results of studies examining the impact of MI on tobacco consumption are contradictory. Moreover, evidence of the effectiveness of MI for modifying well-validated psychophysiological indices of motivational change is still lacking. The aim of the present study was to use the startle probe paradigm and self-report measures of motivational change to assess the effectiveness of MI, compared to Prescriptive Advice (PA) and no treatment, in a sample of 53 smokers (28 male) who were not ready to quit smoking. After the intervention, the MI group reported increased motivation to change compared to both the PA and control groups. MI participants also had a potentiated startle reflex in response to tobacco-related pictures compared to the other two groups. These findings provide evidence that MI reverses the underlying motivational system activated by tobacco related cues.
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Affiliation(s)
- Carlos Gantiva
- University of San Buenaventura, Bogotá, Colombia; University of Granada, Spain
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63
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Peterson J, Prochazka AV, Battaglia C. Smoking cessation and care management for veterans with posttraumatic stress disorder: a study protocol for a randomized controlled trial. BMC Health Serv Res 2015; 15:46. [PMID: 25638351 PMCID: PMC4325951 DOI: 10.1186/s12913-015-0706-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 01/15/2015] [Indexed: 11/29/2022] Open
Abstract
Background Smoking remains the leading cause of preventable illness and mortality in the United States. Individuals with Posttraumatic Stress Disorder (PTSD) have smoking rates higher than that of others and fewer individuals with PTSD have quit smoking. This randomized controlled trial was designed to test the effectiveness of integrating telehealth care management and smoking cessation with motivational interviewing for Veterans with PTSD. Methods/Design All smokers with PTSD, regardless of their desire to quit, were invited to participate. Enrollment occurred between November 2009 and April 2013. Target enrollment was 120 participants. Enrolled participants were randomized to either the control group, receiving usual care including a telehealth PTSD program, with a device that delivered PTSD information and in-home care management, or the intervention group, which included (1) a telehealth PTSD program, (2) motivational interviewing-based smoking cessation curricula via the telehealth device, and (3) weekly motivational interviewing counseling phone calls. Outcomes are self-reported 24-hour quit attempts, progression along the stages of change and 7-day point prevalence quit smoking rates for the intervention group compared to usual care alone. Secondary outcomes include participants’ perception of care coordination, patient satisfaction with motivational interviewing, PTSD symptoms, pain, depression and quality of life. Discussion Motivational interviewing has been shown to increase readiness for change and smoking cessation care has been shown to be more successful when incorporated into in-person mental health care. Our study builds on previous studies. It integrates a written smoking cessation curriculum and phone-based motivational interviewing counseling into an established PTSD home telehealth care coordination program. This paper describes the design and methods of our randomized control trial. Trial registration ClinicalTrials.gov, NCT00908882, May 22, 2009.
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Affiliation(s)
- Jamie Peterson
- Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA.
| | - Allan V Prochazka
- Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA. .,University of Colorado, Aurora, CO, USA.
| | - Catherine Battaglia
- Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA. .,University of Colorado, Aurora, CO, USA.
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Rogers ES, Fu SS, Krebs P, Noorbaloochi S, Nugent SM, Rao R, Schlede C, Sherman SE. Proactive outreach for smokers using VHA mental health clinics: protocol for a patient-randomized clinical trial. BMC Public Health 2014; 14:1294. [PMID: 25518878 PMCID: PMC4301886 DOI: 10.1186/1471-2458-14-1294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/01/2014] [Indexed: 12/03/2022] Open
Abstract
Background Persons with a mental health diagnosis have high rates of tobacco use and face numerous barriers to cessation including high levels of nicotine dependence, low rates of tobacco treatment referrals from mental health providers, and limited availability of tobacco treatment targeted to their needs. This manuscript describes the rationale and methods of a clinical trial with the following aims: 1) Compare the reach and efficacy of a proactive telephone-based tobacco cessation program for Veterans Health Administration (VHA) mental health clinic patients to VHA usual care and 2) Model longitudinal associations between baseline patient characteristics and long-term abstinence. Methods/design We will use the electronic medical record to identify patients across four VHA healthcare facilities who have a clinical reminder code indicating current tobacco use in the past six months and who have had a mental health clinic visit in the past 12 months. We will send each patient an introductory letter and baseline survey. Survey respondents (N = 3840) will be randomized in a 1:1 fashion to intervention or control. Control participants will receive VHA usual care. Intervention participants will receive proactive motivational telephone outreach to offer tobacco treatment. Intervention participants interested in treatment will receive eight weeks of nicotine replacement therapy plus eight sessions of specialized telephone counseling over two months, followed by monthly maintenance counseling for four months. We will conduct telephone surveys with participants at six and 12 months to assess study outcomes. We will collect a mailed saliva sample from patients reporting 7-day abstinence on the telephone surveys. The primary outcome will be cotinine-validated abstinence at 12-month follow-up. Discussion Mental health patients are a high-risk smoking population with significant barriers to cessation. This study will evaluate the efficacy of a program that proactively reaches out to smokers with a mental health treatment history to engage them into telephone cessation counseling targeted to the needs of mental health patients. Trial registration Clinicaltrials.gov: NCT01737281 (registered November 5, 2012).
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Affiliation(s)
- Erin S Rogers
- VA New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA.
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65
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Influence of motivation to quit smoking on the startle reflex: differences between smokers in different stages of change. MOTIVATION AND EMOTION 2014. [DOI: 10.1007/s11031-014-9449-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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66
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Kleinjan M, van den Eijnden RJJM, van Leeuwe J, Brug J, van de Ven MOM, Engels RCME. Adolescents' movement towards cessation of smoking: role and relative value of the processes of change and nicotine dependence. Psychol Health 2014; 23:729-43. [PMID: 25160813 DOI: 10.1080/08870440701757344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The present study addresses the applicability of the Transtheoretical Model's processes of change in explaining adolescents' readiness to quit smoking. Furthermore, the association between nicotine dependence and readiness to quit was assessed both directly, as well as indirectly through the processes of change. A cross-sectional survey was conducted, identifying 1547 weekly smokers aged 14-18 years. Structural equation modelling showed that the processes of change were only marginally associated with readiness to quit. Adding nicotine dependence to the model showed a direct association between nicotine dependence and readiness to quit. Only one process of change, self-liberation (i.e. choice/commitment to change and belief in the ability to change), was found to mediate this association. Nicotine dependence appeared to be highly important in adolescents' readiness to quit.
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Affiliation(s)
- Marloes Kleinjan
- a Addiction Research Institute (IVO) , Rotterdam , The Netherlands
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Dutra LM, Kim SS, Williams DR, Kawachi I, Okechukwu CA. Worksite safety climate, smoking, and the use of protective equipment by blue-collar building workers enrolled in the MassBUILT smoking cessation trial. J Occup Environ Med 2014; 56:1082-7. [PMID: 25285831 PMCID: PMC4187209 DOI: 10.1097/jom.0000000000000233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess potential contributors to high injury rates and smoking prevalence among construction workers, we investigated the association of safety climate with personal protective equipment use, and smoking behaviors. METHODS Logistic regression models estimated risk ratios for personal protective equipment use and smoking using data from participants in MassBUILT smoking cessation intervention (n = 1725). RESULTS Contractor safety climate was negatively associated with the use of dust masks (rate ratio [RR], 0.88; 95% confidence interval [CI], 0.83 to 0.94), respirators (RR, 0.82; 95% CI, 0.75 to 0.89), general equipment (RR, 0.98; 95% CI, 0.95 to 1.00), and fall protection (RR, 0.94; 95% CI, 0.91 to 0.98) and positively associated with current smoking (RR, 1.12; 95% CI, 1.01 to 1.25) but not smoking cessation. Coworker safety climate was negatively associated with the use of dust masks (RR, 0.87; 95% CI, 0.82 to 0.92), respirators (RR, 0.80; 95% CI, 0.74 to 0.87), general equipment (RR, 0.96; 95% CI, 0.94 to 0.98), fall (RR, 0.92; 95% CI, 0.89 to 0.96), and hearing protection (RR, 0.88; 95% CI, 0.83 to 0.93) but not smoking. CONCLUSIONS Worksite safety climate may be important for personal protective equipment use and smoking, but further research is needed.
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Affiliation(s)
- Lauren M Dutra
- University of California San Francisco, Center for Tobacco Research and
Education, 530 Parnassus Avenue, Suite 366, San Francisco, CA 94143-1390 USA
| | - Seung-Sup Kim
- Korea University, Department of Epidemiology, 145, Anam-ro, Seongbuk-gu,
Seoul, 136-701 Korea
| | - David R Williams
- Harvard School of Public Health, Department of Social and Behavioral
Sciences, 677 Huntington Avenue; Boston, MA 02115 USA
| | - Ichiro Kawachi
- Harvard School of Public Health, Department of Social and Behavioral
Sciences, 677 Huntington Avenue; Boston, MA 02115 USA
| | - Cassandra A Okechukwu
- Harvard School of Public Health, Department of Social and Behavioral
Sciences, 677 Huntington Avenue; Boston, MA 02115 USA
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Schuck RK, Dahl A, Hall SM, Delucchi K, Fromont SC, Hall SE, Bonas T, Prochaska JJ. Smokers with serious mental illness and requests for nicotine replacement therapy post-hospitalisation. Tob Control 2014; 25:27-32. [PMID: 25209524 DOI: 10.1136/tobaccocontrol-2014-051712] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/22/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS Smoke-free psychiatric hospitalisation provides opportunity for initiating tobacco cessation treatment. The current study reports on psychiatric patients' interest in continuing nicotine replacement therapy (NRT) posthospitalisation and examines patient predictors of NRT requests, quit attempts and abstinence at 1-week follow-up. METHODS Daily smokers were recruited and interviewed on locked psychiatric units at three smoke-free San Francisco Bay Area hospitals. Intent to quit smoking was not required to participate and 73% of eligible smokers enrolled. Analyses focused on 816 participants (49% female) randomised to interventions providing counselling tailored to readiness to quit with availability of NRT posthospitalisation. Logistic regressions tested demographic, smoking and psychiatric factors predictive of NRT requests, quit attempts and abstinence 1-week postdischarge. RESULTS Participants averaged 17 (SD=10) cigarettes/day for an average of 19 (SD=14) years. Most (88%) requested study-provided NRT (74% right at discharge). Participants preparing to quit and those with more severe psychiatric symptoms were more likely to request NRT at discharge (p<0.01). Those with more severe psychiatric symptoms also were more likely to request NRT refill, as were older participants (p<0.05). Participants who requested NRT at discharge were more likely to make a 24 h quit attempt and self-report abstinence at the 1-week follow-up (54% quit attempt, 14% abstinent) than participants who did not (25% quit attempt, 4% abstinent) (p<0.05). CONCLUSIONS The great demand for NRT and the association between NRT use with quit attempts and abstinence at 1-week posthospitalisation supports adoption of tobacco treatment in acute psychiatric settings. TRIAL REGISTRATION NUMBER # NCT00968513.
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Affiliation(s)
- Rachel K Schuck
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, California, USA
| | - Audun Dahl
- Department of Psychology, University of California, Santa Cruz, Santa Cruz, California, USA
| | - Sharon M Hall
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Kevin Delucchi
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Sebastien C Fromont
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Stephen E Hall
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Thomas Bonas
- Alta Bates Summit Medical Center, Herrick Hospital, Berkeley, California, USA
| | - Judith J Prochaska
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, California, USA Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
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Jardin BF, Cropsey KL, Wahlquist AE, Gray KM, Silvestri GA, Cummings KM, Carpenter MJ. Evaluating the effect of access to free medication to quit smoking: a clinical trial testing the role of motivation. Nicotine Tob Res 2014; 16:992-9. [PMID: 24610399 PMCID: PMC4133568 DOI: 10.1093/ntr/ntu025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/01/2014] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Although the majority of smokers are ambivalent about quitting, few treatments specifically target smokers lacking motivation to quit in the near future. Most existing interventions are instead predicated on the belief that active treatments should only be distributed to smokers interested in quitting, a largely untested assumption. METHODS In the current clinical trial (N = 157), motivated smokers wanting to quit in the next 30 days were given a 2-week nicotine replacement therapy (NRT) sample and a referral to a quitline (Group MNQ), while unmotivated smokers were randomized to receive the same treatment (Group UNQ) or a quitline referral only (Group UQ). Participants were tracked via telephone for 3 months to assess quitting behaviors and smoking reduction. RESULTS Groups significantly differed across all comparisons with regard to incidence of any quit attempt (MNQ: 77%, UNQ: 40%, UQ: 18%, p < .05) and any 24-hr quit attempts (62%, 32%, 16%, p < .05). Clinically meaningful differences emerged in the rates of floating (19%, 17%, 6%) and point prevalence abstinence (17%, 15%, 5%). Compared to participants in Group UQ (11%), a greater proportion of participants in Group MNQ (48%, p = .01) and Group UNQ (31%, p = .01) reduced their daily cigarette consumption by at least half. Proxy measures of cessation readiness (e.g., motivation) favored participants receiving active forms of treatment. CONCLUSIONS Providing NRT samples engaged both motivated and unmotivated smokers into the quitting process and produced positive changes in smoking outcomes. This suggests that motivation should not be considered a necessary precondition to receiving treatment.
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Affiliation(s)
- Bianca F Jardin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL
| | - Amy E Wahlquist
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Gerard A Silvestri
- Department of Medicine, Division of Pulmonary/Critical Care Medicine, Medical University of South Carolina, Charleston, SC
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC;
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Assessing the extent to which healthcare workers advised and assisted smokers to quit based on patient motivation levels. J Addict Nurs 2014; 25:81-6; quiz 87-8. [PMID: 24905757 DOI: 10.1097/jan.0000000000000025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Smoking remains the leading cause of preventable death in the United States. Although healthcare workers play a key role in helping patients quit smoking, the degree to which they provide help varies. This study assesses the extent to which smokers report that their healthcare worker advised and assisted them with quitting based on their level of readiness to make a change. The 2006 Hawaii Adult Tobacco Survey asked questions regarding smoking status and if advice and assistance with quitting was given from a healthcare worker. Percentages for reporting healthcare worker's advice and assistance were compared among the three levels of motivational readiness using the chi-square test of association for 331 current, everyday smokers (56% women; 38% in the age group of 45-54 years). Most smokers are given advice to quit smoking. However, only about half of those motivated to quit are given assistance to do so. Most smokers across all motivation levels received advice to quit smoking with no significant difference between levels of readiness to quit. Less than half of smokers received any type of assistance with quitting smoking, with higher motivated smokers significantly receiving more assistance with cessation medication or nicotine replacement therapy and setting a quit date. This is a call to action for healthcare workers to address smoking with every patient. Adjustments to protocols for addressing smoking cessation and readiness to quit may be warranted.
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71
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Dutra LM, Williams DR, Kawachi I, Okechukwu CA. Racial and non-racial discrimination and smoking status among South African adults 10 years after apartheid. Tob Control 2014; 23:e114-21. [PMID: 24789604 DOI: 10.1136/tobaccocontrol-2013-051478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite a long history of discrimination and persisting racial disparities in smoking prevalence, little research exists on the relationship between discrimination and smoking in South Africa. METHODS This analysis examined chronic (day-to-day) and acute (lifetime) experiences of racial and non-racial (eg, age, gender or physical appearance) discrimination and smoking status among respondents to the South Africa Stress and Health study. Logistic regression models were constructed using SAS-Callable SUDAAN. RESULTS Both chronic racial discrimination (RR=1.45, 95% CI 1.14 to 1.85) and chronic non-racial discrimination (RR=1.69, 95% CI 1.37 to 2.08) predicted a higher risk of smoking, but neither type of acute discrimination did. Total (sum of racial and non-racial) chronic discrimination (RR=1.46, 95% CI 1.20 to 1.78) and total acute discrimination (RR=1.28, 95% CI 1.01 to 1.60) predicted a higher risk of current smoking. CONCLUSIONS Racial and non-racial discrimination may be related to South African adults' smoking behaviour, but this relationship likely varies by the timing and frequency of these experiences. Future research should use longitudinal data to identify the temporal ordering of the relationships studied, include areas outside of South Africa to increase generalisability and consider the implications of these findings for smoking cessation approaches in South Africa.
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Affiliation(s)
- Lauren M Dutra
- The Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Cassandra A Okechukwu
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
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McClure JB, Peterson D, Derry H, Riggs K, Saint-Johnson J, Nair V, An L, Shortreed SM. Exploring the "active ingredients" of an online smoking intervention: a randomized factorial trial. Nicotine Tob Res 2014; 16:1129-39. [PMID: 24727369 DOI: 10.1093/ntr/ntu057] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Research needs to systematically identify which components increase online intervention effectiveness (i.e., active ingredients). This study explores the effects of 4 potentially important design features in an Internet-based, population-level smoking intervention. METHODS Smokers (n = 1,865) were recruited from a large health care organization, regardless of readiness to quit. Using a full factorial design, participants were randomized to 1 of the 2 levels of each experimental factor (message tone [prescriptive vs. motivational], navigation autonomy [dictated vs. not], e-mail reminders [yes vs. no], and receipt of personally tailored testimonials [yes vs. no]) and provided access to the online intervention. Primary outcomes were self-reported 7-day point-prevalent smoking abstinence and confirmed utilization of adjunct treatment (pharmacotherapy or phone counseling) available through the health plan at 1 year. Outcomes were also assessed at 2 and 6 months and were examined among all enrolled participants (intent-to-treat [ITT]) and all who viewed the intervention (modified ITT). RESULTS At 1 year, 13.7% were abstinent and 26.0% utilized adjunct treatment. None of the contrasting factor levels differentially influenced abstinence or treatment utilization at 12 months. In the modified ITT sample, smokers receiving testimonials were less likely to use adjunct treatment at 6 months (odds ratio = 0.54, 95% confidence interval = 0.30-0.98, p = .04). CONCLUSIONS None of the design features enhanced treatment outcome. The negative effect observed for testimonials is provocative, but it should be viewed with caution. This study offers a model for future research testing the "active ingredients" of online interventions.
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Affiliation(s)
| | - Do Peterson
- Group Health Research Institute, Seattle, WA
| | - Holly Derry
- Center for Health Communications Research, University of Michigan, Ann Arbor, MI
| | - Karin Riggs
- Group Health Research Institute, Seattle, WA
| | | | - Vijay Nair
- Department of Statistics, University of Michigan, Ann Arbor, MI
| | - Lawrence An
- Center for Health Communications Research, University of Michigan, Ann Arbor, MI
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BinDhim NF, McGeechan K, Trevena L. Who Uses Smoking Cessation Apps? A Feasibility Study Across Three Countries via Smartphones. JMIR Mhealth Uhealth 2014; 2:e4. [PMID: 25098439 PMCID: PMC4114511 DOI: 10.2196/mhealth.2841] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/24/2013] [Accepted: 12/05/2013] [Indexed: 12/17/2022] Open
Abstract
Background Smartphone use is growing worldwide. While hundreds of smoking cessation apps are currently available in the app stores, there is no information about who uses them. Smartphones also offer potential as a research tool, but this has not previously been explored. Objective This study aims to measure and compare the uptake of a smoking cessation app over one year in Australia, the United Kingdom, and the United States. It also assesses the feasibility of conducting research via an app, describing respondents’ characteristics (demographics, smoking status, and other health related app use), and examining differences across countries. Methods This is a cross-sectional exploratory study of adults 18 years and older, passively recruited over one year in 2012, who downloaded this study app (Quit Advisor) via the two largest app stores (Apple and Android). Results The total number of app downloads after one year was 1751, 72.98% (1278/1751) of them were Apple operation system users. Of these 1751 participants, 47.68% (835/1751) were from the United States, 29.18% (511/1751) were from the United Kingdom, and 16.68% (292/1751) were from Australia. There were 602 participants, 36.75% (602/1638) that completed a questionnaire within the app. Of these 602 participants, 58.8% (354/602) were female and the mean age was 32 years. There were no significant differences between countries in terms of age, operation system used, number of quitting attempts, and language spoken at home. However, there were significant differences between countries in terms of gender and stage of change. There were 77.2% (465/602) of the respondents that were ready to quit in the next 30 days and the majority of these had never sought professional help (eg, “Quitline”). More than half had downloaded smoking cessation apps in the past and of these, three-quarters had made quitting attempts (lasted at least 24 hours) using an app before. Respondents who had attempted to quit three times or more in the previous year were more likely to have tried smoking cessation apps (OR 3.3, 95% CI 2.1-5.2). There were 50.2% (302/602) of the respondents that had used other health related apps before. Of these, 89.4% (270/302) were using health related apps at least once a week, but 77.5% (234/302) never checked the credibility of the health app publishers before downloading. Conclusions A smartphone app was able to reach smokers across three countries that were not seeking professional help, but were ready to quit within the next 30 days. Respondents were relatively young and almost demographically similar across all three countries. They also frequently used other health related apps, mostly without checking the credibility of their publishers.
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Affiliation(s)
- Nasser F BinDhim
- Sydney Medical School, Department of Public Health, University of Sydney, Sydney, Australia.
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Prochaska JJ, Fromont SC, Delucchi K, Young-Wolff KC, Benowitz NL, Hall S, Bonas T, Hall SM. Multiple risk-behavior profiles of smokers with serious mental illness and motivation for change. Health Psychol 2014; 33:1518-29. [PMID: 24467257 DOI: 10.1037/a0035164] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Individuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs. METHOD Recruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization. RESULTS Participants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence. CONCLUSION Most smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health.
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Affiliation(s)
- Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | | | - Kevin Delucchi
- Department of Psychiatry, University of California-San Francisco
| | - Kelly C Young-Wolff
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | - Neal L Benowitz
- Division of Clinical Pharmacology, Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California-San Francisco
| | - Stephen Hall
- Department of Psychiatry, University of California-San Francisco
| | | | - Sharon M Hall
- Department of Psychiatry, University of California-San Francisco
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Haddad L, Corcoran J. Culturally tailored smoking cessation for arab american male smokers in community settings: a pilot study. Tob Use Insights 2013; 6:17-23. [PMID: 25774085 PMCID: PMC4349233 DOI: 10.4137/tui.s11837] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tobacco use is a serious public health problem among Arab Americans with limited English proficiency. The main goal of this study was to develop a culturally-tailored and linguistically-sensitive Arabic-language smoking cessation program. A secondary goal was to evaluate the feasibility of recruiting Arab Americans through a faith-based community organization which serves as a neighborhood social center for the city of Richmond’s Arab Americans. Eight first-generation Arab American men aged 20 years and above completed the three-month program. There was general agreement of the following: (1) each stage of the five-stage cessation program could be improved; (2) several glaring errors could be easily corrected; and (3) minor variation among the various countries-of-origin of participants could lead to a few changes in the program with respect to the use of some colloquial terms. The results suggest that it is possible to reach smokers from Arab American communities with a tailored Arabic language smoking cessation program. The findings of this report will be used as the basis for a large-scale intervention study of a culturally and linguistically sensitive cessation program for Arab American ethnic groups.
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Affiliation(s)
- Linda Haddad
- School of Nursing and Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jacqueline Corcoran
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
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Lim KH, Ibrahim N, Ghazali SM, Kee CC, Lim KK, Chan YY, Teh CH, Tee EO, Lai WY, Nik Mohamad MH, Sidek SM. Stages of smoking cessation among Malaysian adults--findings from national health morbidity survey 2006. Asian Pac J Cancer Prev 2013; 14:805-10. [PMID: 23621242 DOI: 10.7314/apjcp.2013.14.2.805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Increasing the rate of smoking cessation will reduce the burden of diseases related to smoking, including cancer. Understanding the process of smoking cessation is a pre-requisite to planning and developing effective programs to enhance the rate of smoking cessation.The aims of the study were to determine the demographic distribution of smokers across the initial stages of smoking cessation (the pre-contemplation and contemplation stages) and to identify the predictors of smoking cessation among Malaysian adult smokers. Data were extracted from a population-based, cross-sectional survey carried out from April 2006 to July 2006. The distribution of 2,716,743 current smokers across the pre-contemplation stage (no intention to quit smoking in the next six months) or contemplation stage (intended to quit smoking in the next six months) was described. Multivariable logistic regression analysis was used to examine the relationship between socio-demographic variables and the stages of smoking cessation. Of the 2,716,743 current smokers, approximately 30% and 70% were in the pre-contemplative and contemplative stages of smoking cessation respectively. Multivariable analysis showed that male gender, low education level, older age group, married and those from higher income group and number of cigarettes smoked were associated with higher likelihood of pre-contemplation to cease smoking in the next six months. The majority of current smokers in Malaysia were in the contemplative stage of smoking cessation. Specific interventions should be implemented to ensure the pre-contemplative smokers proceed to the contemplative stage and eventually to the preparation stage.
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Affiliation(s)
- Kuang Hock Lim
- Institute for Public Health, Jalan Pahang, Kuala Lumpur, Malaysia.
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Tyc VL, Puleo E, Emmons K, de Moor JS, Ford JS. Smoking Restrictions Among Households of Childhood and Young Adult Cancer Survivors: Implications for Tobacco Control Efforts. J Adolesc Young Adult Oncol 2013; 2:17-24. [PMID: 23610739 DOI: 10.1089/jayao.2012.0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study assessed the prevalence of smoking restrictions among households of survivors of childhood and young adult cancer who smoke. It also examined the relationship between home smoking restrictions and motivation to quit smoking, as well as other smoking, psychosocial, and environmental factors. METHODS Participants included 374 smokers who were childhood or young adult cancer survivors (between the ages of 18 and 55 years) recruited from five cancer centers to participate in a randomized smoking cessation trial. Survivors completed baseline measures about the smoking restrictions in their households, their smoking behavior, and related psychological and environmental factors, which are the focus of the current manuscript. RESULTS Almost 54% of survivors reported that smoking was prohibited in their households. Living with a nonsmoking partner, having a strict smoking policy at work, and not being nicotine dependent all increased the likelihood of having a total home smoking ban. Participants who were older, smoked more cigarettes per day over the prior week, and received prior chemotherapy were less likely to reside in households that adopted total bans. CONCLUSION Findings suggest that socio-environmental factors and current smoking behaviors are associated with complete smoking restrictions in the homes of survivors. These factors should be considered when communicating with survivors about the importance of establishing strict smoking policies in their private residences.
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Affiliation(s)
- Vida L Tyc
- St. Jude Children's Research Hospital , Memphis, Tennessee
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78
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Friebely J, Rigotti NA, Chang Y, Hall N, Weiley V, Dempsey J, Hipple B, Nabi-Burza E, Murphy S, Woo H, Winickoff JP. Parent smoker role conflict and planning to quit smoking: a cross-sectional study. BMC Public Health 2013; 13:164. [PMID: 23433098 PMCID: PMC3600049 DOI: 10.1186/1471-2458-13-164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 01/31/2013] [Indexed: 11/18/2022] Open
Abstract
Background Role conflict can motivate behavior change. No prior studies have explored the association between parent/smoker role conflict and readiness to quit. The objective of the study is to assess the association of a measure of parent/smoker role conflict with other parent and child characteristics and to test the hypothesis that parent/smoker role conflict is associated with a parent’s intention to quit smoking in the next 30 days. As part of a cluster randomized controlled trial to address parental smoking (Clinical Effort Against Secondhand Smoke Exposure—CEASE), research assistants completed exit interviews with 1980 parents whose children had been seen in 20 Pediatric Research in Office Settings (PROS) practices and asked a novel identity-conflict question about “how strongly you agree or disagree” with the statement, “My being a smoker gets in the way of my being a parent.” Response choices were dichotomized as “Strongly Agree” or “Agree” versus “Disagree” or “Strongly Disagree” for the analysis. Parents were also asked whether they were “seriously planning to quit smoking in 30 days.” Chi-square and logistic regression were performed to assess the association between role conflict and other parent/children characteristics. A similar strategy was used to determine whether role conflict was independently associated with intention to quit in the next 30 days. Methods As part of a RTC in 20 pediatric practices, exit interviews were held with smoking parents after their child’s exam. Parents who smoked were asked questions about smoking behavior, smoke-free home and car rules, and role conflict. Role conflict was assessed with the question, “Please tell me how strongly you agree or disagree with the statement: ‘My being a smoker gets in the way of my being a parent.’ (Answer choices were: “Strongly agree, Agree, Disagree, Strongly Disagree.”) Results Of 1980 eligible smokers identified, 1935 (97%) responded to the role-conflict question, and of those, 563 (29%) reported experiencing conflict. Factors that were significantly associated with parent/smoker role conflict in the multivariable model included: being non-Hispanic white, allowing home smoking, the child being seen that day for a sick visit, parents receiving any assistance for their smoking, and planning to quit in the next 30 days. In a separate multivariable logistic regression model, parent/smoker role conflict was independently associated with intention to quit in the next 30 days [AOR 2.25 (95% CI 1.80-2.18)]. Conclusion This study demonstrated an association between parent/smoker role conflict and readiness to quit. Interventions that increase parent/smoker role conflict might act to increase readiness to quit among parents who smoke. Trial registration Clinical trial registration number: NCT00664261.
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Affiliation(s)
- Joan Friebely
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital, Boston, MA, USA
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Tzelepis F, Paul CL, Walsh RA, Wiggers J, Duncan SL, Knight J. Predictors of abstinence among smokers recruited actively to quitline support. Addiction 2013; 108:181-5. [PMID: 22928579 PMCID: PMC3563228 DOI: 10.1111/j.1360-0443.2012.03998.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/12/2012] [Accepted: 06/19/2012] [Indexed: 11/26/2022]
Abstract
AIMS Active recruitment of smokers increases the reach of quitlines; however, some quitlines restrict proactive telephone counselling (i.e. counsellor-initiated calls) to smokers ready to quit within 30 days. Identifying characteristics associated with successful quitting by actively recruited smokers could help to distinguish those most likely to benefit from proactive telephone counselling. This study assessed the baseline characteristics of actively recruited smokers associated with prolonged abstinence at 4, 7 and 13 months and the proportion achieving prolonged abstinence that would miss out on proactive telephone counselling if such support was offered only to smokers intending to quit within 30 days at baseline. DESIGN Secondary analysis of a randomized controlled trial in which the baseline characteristics associated with prolonged abstinence were examined. SETTING New South Wales (NSW) community, Australia. PARTICIPANTS A total of 1562 smokers recruited at random from the electronic NSW telephone directory. MEASUREMENTS Baseline socio-demographic and smoking-related characteristics associated with prolonged abstinence at 4, 7 and 13 months post-recruitment. FINDINGS Waiting more than an hour to smoke after waking and intention to quit within 30 days at baseline predicted five of the six prolonged abstinence measures. If proactive telephone counselling was restricted to smokers who at baseline intended to quit within 30 days, 53.8-65.9% of experimental group participants who achieved prolonged abstinence would miss out on telephone support. CONCLUSIONS Less addicted and more motivated smokers who are actively recruited to quitline support are more likely to achieve abstinence. Most actively recruited smokers reported no intention to quit within the next 30 days, but such smokers still achieved long-term abstinence.
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Affiliation(s)
- Flora Tzelepis
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.
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80
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Boudreaux ED, Bedek KL, Byrne NJ, Baumann BM, Lord SA, Grissom G. The Computer-Assisted Brief Intervention for Tobacco (CABIT) program: a pilot study. J Med Internet Res 2012. [PMID: 23208070 PMCID: PMC3799483 DOI: 10.2196/jmir.2074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Health care providers do not routinely carry out brief counseling for tobacco cessation despite the evidence for its effectiveness. For this intervention to be routinely used, it must be brief, be convenient, require little investment of resources, require little specialized training, and be perceived as efficacious by providers. Technological advances hold much potential for addressing the barriers preventing the integration of brief interventions for tobacco cessation into the health care setting. Objective This paper describes the development and initial evaluation of the Computer-Assisted Brief Intervention for Tobacco (CABIT) program, a web-based, multimedia tobacco intervention for use in opportunistic settings. Methods The CABIT uses a self-administered, computerized assessment to produce personalized health care provider and patient reports, and cue a stage-matched video intervention. Respondents interested in changing their tobacco use are offered a faxed referral to a “best matched” tobacco treatment provider (ie, dynamic referral). During 2008, the CABIT program was evaluated in an emergency department, an employee assistance program, and a tobacco dependence program in New Jersey. Participants and health care providers completed semistructured interviews and satisfaction ratings of the assessment, reports, video intervention, and referrals using a 5-point scale. Results Mean patient satisfaction scores (n = 67) for all domains ranged from 4.00 (Good) to 5.00 (Excellent; Mean = 4.48). Health care providers completed satisfaction forms for 39 patients. Of these 39 patients, 34 (87%) received tobacco resources and referrals they would not have received under standard care. Of the 45 participants offered a dynamic referral, 28 (62%) accepted. Conclusions The CABIT program provided a user-friendly, desirable service for tobacco users and their health care providers. Further development and clinical trial testing is warranted to establish its effectiveness in promoting treatment engagement and tobacco cessation.
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Affiliation(s)
- Edwin D Boudreaux
- University of Massachusetts Medical School, Emergency Medicine, Worcester, United States.
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Dohnke B, Ziemann C, Will K, Weiss-Gerlach E, Spies C. Do hospital treatments represent a ‘teachable moment’ for quitting smoking? A study from a stage-theoretical perspective. Psychol Health 2012; 27:1291-307. [DOI: 10.1080/08870446.2012.672649] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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McClure JB, Derry H, Riggs KR, Westbrook EW, St John J, Shortreed SM, Bogart A, An LC. Questions about quitting (Q2): design and methods of a Multiphase Optimization Strategy (MOST) randomized screening experiment for an online, motivational smoking cessation intervention. Contemp Clin Trials 2012; 33:1094-102. [PMID: 22771577 DOI: 10.1016/j.cct.2012.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022]
Abstract
Effective interventions are needed to improve smokers' motivation for quitting, treatment utilization, and abstinence rates. The Internet provides an ideal modality for delivering such interventions, given the low cost, broad reach, and capacity to individually tailor content, but important methodological questions remain about how to best design and deliver an online, motivational intervention to smokers. The current paper reports on the intervention, study design and research methods of a randomized trial (called Questions about Quitting) designed to address some of these questions. Using a Multi-phase Optimization Strategy (MOST) screening experiment, the trial has two key aims: to examine the impact of four experimental intervention factors (each evaluated on two levels) on smokers' subsequent treatment utilization and abstinence, and to examine select moderators of each sub-factor's effectiveness. The experimental factors of interest are: navigation autonomy (content viewing order is dictated based on stage of change or not), use of self-efficacy based testimonials (yes vs. no), proactive outreach (reminder emails vs. no emails), and decisional framework (prescriptive vs. motivational tone). To our knowledge, this is the first application of the MOST methodology to explore these factors or to explore the optimal design for a motivational intervention targeting smokers not actively trying to quit smoking. The rationale for the experimental factor choice, intervention design, and trial methods are discussed. Outcome data are currently being collected and are not presented, but recruitment data confirm the feasibility of enrolling smokers at varying stages of readiness to quit.
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Affiliation(s)
- J B McClure
- Group Health Research Institute, Seattle, WA 98101, USA.
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83
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Interest in participating in smoking cessation treatment among Latino primary care patients. J Clin Psychol Med Settings 2012; 18:392-9. [PMID: 21984387 DOI: 10.1007/s10880-011-9259-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Smoking is the leading preventable cause of disease and death for U.S. Latinos. This study identified correlates of interest in participating in a smoking cessation program among urban Latinos seen in community clinics. Interviews were completed with 141 current smokers. Participants were predominantly Spanish-speaking (93%) males (66%), who were on average 37.6 years old and smoked 8.7 cigarettes per day. Over two-thirds (63%) of participants were "definitely interested" in participating in a smoking cessation program. Participants who smoked more cigarettes per day and reported greater nicotine dependence, depression, and readiness to quit were more likely to be interested, while those employed fulltime were less likely to report high interest. Treatment preferences were consistent with Clinical Practice Guidelines recommending counseling, social support, and pharmacotherapy. Results support recommendations that healthcare providers intervene with all Latino smokers, including light smokers and those who do not report initial interest in smoking cessation.
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84
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Gilbert H, Sutton S, Leurent B, Alexis-Garsee C, Morris R, Nazareth I. Characteristics of a population-wide sample of smokers recruited proactively for the ESCAPE trial. Public Health 2012; 126:308-16. [DOI: 10.1016/j.puhe.2011.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 11/29/2011] [Indexed: 10/28/2022]
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Stoltzfus K, Ellerbeck EF, Hunt S, Rabius V, Carlini B, Ayers C, Richter KP. A Pilot Trial of Proactive Versus Reactive Referral to Tobacco Quitlines. J Smok Cessat 2012. [DOI: 10.1375/jsc.6.2.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AbstractOverview:Many U.S. hospitals use fax-referral to quitlines to provide outpatient follow-up. It is important to understand whether it is better to refer all smokers, or only those ready to quit, to quitline services. The purpose of this pilot project was to evaluate the feasibility and intermediate out-comes of a proactive (offering fax referral to all smokers) versus a reactive (pre-screening for readiness to quit within the next 30 days) approach to quitline fax-referral.Method:We employed a pre-test, post-test comparison group design in which a script-based reactive approach was employed over a two-week period and a script-based proactive approach was employed in the following two-week period. Scripts were inserted into the counselling protocols of a pre-existing inpatient treatment program.Major Findings:We enrolled 45 patients — 25 during the reactive, and 20 during the proactive block. In the reactive group, 12 (48%) indicated that they were ready to quit smoking and accepted fax-referral to the quitline. Nine (75%) were successfully contacted and enrolled in the quitline, for an overall quitline enrolment rate of 36% (9/25). In the proactive group, all accepted fax-referral to the quitline and 11 were successfully contacted and enrolled by the quitline for an overall enrolment rate of 55% (11/20). Quitlines were able to reach and enrol a higher proportion of patients referred to them, when patients were pre-screened for readiness to quit. Offering quitline referral, regardless of readiness to quit, potentially expands the reach and possibly the impact of quitline counselling.
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Tzelepis F, Paul CL, Duncan SL, Walsh RA, Wiggers J, Knight J. Increasing the Reach of Quitlines Through Active Telephone Recruitment: Do Cold-Called Smokers Differ From Quitline Callers? Nicotine Tob Res 2012; 14:1488-93. [DOI: 10.1093/ntr/ntr317] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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87
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Barreto RB, Pincelli MP, Steinwandter R, Silva AP, Manes J, Steidle LJM. Tabagismo entre pacientes internados em um hospital universitário no sul do Brasil: prevalência, grau de dependência e estágio motivacional. J Bras Pneumol 2012; 38:72-80. [DOI: 10.1590/s1806-37132012000100011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 09/29/2011] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a prevalência e o perfil do tabagismo em pacientes internados em um hospital universitário no sul do Brasil. MÉTODOS: Estudo descritivo transversal com pacientes maiores de 18 anos hospitalizados há mais de 24 h no Hospital Universitário da Universidade de Santa Catarina em Florianópolis. Os pacientes foram entrevistados em duas ocasiões distintas. Dados demográficos, socioeconômicos e ligados ao tabagismo foram coletados. RESULTADOS: Foram entrevistados 235 pacientes: 44 (18,7%) eram tabagistas; 77 (32,8%) eram ex-tabagistas; 114 (48,5%) eram não tabagistas e 109 (46,7%) eram tabagistas passivos. A média de idade dos fumantes foi de 45,7 ± 15,2 anos, e 29 (65,9%) eram do sexo masculino. Entre os fumantes, a mediana da idade de início do tabagismo foi de 15 anos; a carga tabágica média foi de 32 ± 30,2 anos-maço; 36 (81,9%) tinham consumo diário de até 20 cigarros; 20 (45,4%) tinham grau de dependência à nicotina elevada ou muito elevada; 32 (72,7%) já haviam tentado cessar, 39 (88,6%) gostariam de cessar, 32 (72,7%) aceitariam receber tratamento, 13 (29,5%) fumaram durante a internação, e 13 (29,5%) apresentaram síndrome de abstinência. Houve um aumento no número de pacientes nos estágios motivacionais de preparação e ação durante a internação (de 31,8% para 54,8%). CONCLUSÕES: A prevalência de tabagismo no estudo foi semelhante à encontrada em outros estudos no Brasil. Os resultados sugerem que nossa amostra foi significativa em relação à população de fumantes hospitalizados, que se encontra motivada à cessação do hábito tabágico durante a hospitalização, necessitando de uma abordagem sistematizada para a cessação.
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Affiliation(s)
| | | | | | | | - Jóice Manes
- Universidade Federal de Santa Catarina, Brasil
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Richter KP, Hunt JJ, Cupertino AP, Garrett S, Friedmann PD. Understanding the drug treatment community's ambivalence towards tobacco use and treatment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:220-8. [PMID: 22280918 DOI: 10.1016/j.drugpo.2011.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 10/12/2011] [Accepted: 11/21/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most clients in drug treatment smoke cigarettes, but few facilities provide treatment for tobacco dependence. We identify subjective experiences and social processes that may influence facility adoption of tobacco treatment policies and practices. METHODS Cross-sectional, semi-structured interviews were conducted with staff, directors and clients of 8 drug treatment facilities in the Midwestern U.S. We assembled a purposive sample stratified by ownership, methadone provision, and treatment service provision. We conducted in-person interviews with clinic directors and 54 staff and clients and employed a mixed-method analytic approach. RESULTS Facility policies and philosophy related to tobacco differed from those regarding alcohol and other drugs. Participants suggested facilities may not treat tobacco dependence because it does not create legal and social problems that force clients into treatment. Tobacco dependence treatment falls outside of a core function of drug treatment, which is to help clients fix legal problems caused by their drug use. Moreover, proactively treating clients for tobacco dependence creates strong ambivalence amongst staff and directors. On the one hand, staff smoking would violate core principles of drug treatment (i.e., the importance of staff abstinence from drugs of abuse); on the other, staff who smoke feel their personal rights and jobs are threatened. This situation creates strong incentives for staff to resist adoption of tobacco dependence treatment. Unlike other studies, the fear of jeopardising clients' abstinence from other drugs did not emerge as a downside for treating tobacco dependence. CONCLUSIONS International and national trends will probably increase the pressure to treat tobacco dependence during drug treatment. However, the U.S. context of drug treatment, as a patchwork, under-funded industry with high employee turnover, may undermine true adoption. At present, many facility staff resolve their ambivalence by reporting they "offer" treatment, but actually providing none. To facilitate dissemination of service provision, it may be useful to identify incentives for U.S. facilities that are closely aligned with the criminal justice system, help facilities define policies and treatment roles for staff who smoke, and better define the role of facilities in preventing morbidity and mortality.
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Affiliation(s)
- Kimber P Richter
- University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas City, KS, USA
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Levinson AH, Hood N, Mahajan R, Russ R. Smoking cessation treatment preferences, intentions, and behaviors among a large sample of Colorado gay, lesbian, bisexual, and transgendered smokers. Nicotine Tob Res 2012; 14:910-8. [PMID: 22259147 DOI: 10.1093/ntr/ntr303] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Little is known about preferences, intentions, and behaviors regarding evidence-based cessation treatment for smoking cessation among gay, lesbian, bisexual, and transgendered (GLBT) adults. METHODS We obtained and analyzed questionnaire responses from GLBT smokers (n= 1,633) surveyed in 129 GLBT-identified Colorado venues and online during 2007. RESULTS Most respondents (80.4%) smoked daily. Nearly one-third smoked 20 or more cigarettes/day. Fewer than half (47.2%) had attempted quitting in the previous year, and only 8.5% were preparing to quit in the next month. More than one-fourth (28.2%) of quit attempters had used nicotine replacement therapy (NRT), and a similar proportion said they intended to use NRT in their next quit attempt. Lesbians were significantly less likely than gay men to have used or intend to use NRT. One-fourth of respondents said they were uncomfortable talking to their doctor about quitting smoking. Four factors (daily smoking, ever having used NRT, a smoke-free home rule, and comfort asking one's doctor for cessation advice) were associated with preparation to quit smoking. CONCLUSIONS GLBT self-identification was not associated with lower than average acceptance of evidence-based smoking cessation strategies, especially NRT, but a large minority of GLBT smokers were unlikely to seek cessation assistance through clinical encounters. Public health campaigns should focus on supporting motivation to quit and providing nonclinical access to evidence-based treatments.
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Affiliation(s)
- Arnold H Levinson
- Division of Cancer Prevention & Control, University of Colorado Cancer Center, 13001 East 17th Place, Mail Stop F542, Aurora, CO 80045, USA.
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Mani D, Haigentz M, Aboulafia DM. Lung cancer in HIV Infection. Clin Lung Cancer 2012; 13:6-13. [PMID: 21802373 PMCID: PMC3256276 DOI: 10.1016/j.cllc.2011.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/14/2011] [Accepted: 05/23/2011] [Indexed: 12/20/2022]
Abstract
Lung cancer is the most prevalent non-AIDS-defining malignancy in the highly active antiretroviral therapy era. Smoking plays a significant role in the development of HIV-associated lung cancer, but the cancer risk is two to four times greater in HIV-infected persons than in the general population, even after adjusting for smoking intensity and duration. Lung cancer is typically diagnosed a decade or more earlier among HIV-infected persons (mean age, 46 years) compared to those without HIV infection. Adenocarcinoma is the most common histological subtype, and the majority of patients are diagnosed with locally advanced or metastatic carcinoma. Because pulmonary infections are common among HIV-infected individuals, clinicians may not suspect lung cancer in this younger patient population. Surgery with curative intent remains the treatment of choice for early-stage disease. Although there is increasing experience in using radiation and chemotherapy for HIV-infected patients who do not have surgical options, there is a need for prospective studies because this population is frequently excluded from participating in cancer trials. Evidence-based treatments for smoking-cessation with demonstrated efficacy in the general population must be routinely incorporated into the care of HIV-positive smokers.
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Affiliation(s)
- Deepthi Mani
- Division of Internal Medicine, Providence Sacred Heart Medical Center, Spokane, WA 98111, USA
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BOWMAN JENNY, WIGGERS JOHN, COLYVAS KIM, WYE PAULA, WALSH RAOULA, BARTLEM KATE. Smoking cessation among Australian methadone clients: Prevalence, characteristics and a need for action. Drug Alcohol Rev 2011; 31:507-13. [DOI: 10.1111/j.1465-3362.2011.00408.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Amiya RM, Poudel KC, Poudel-Tandukar K, Kobayashi J, Pandey BD, Jimba M. Physicians are a key to encouraging cessation of smoking among people living with HIV/AIDS: a cross-sectional study in the Kathmandu Valley, Nepal. BMC Public Health 2011; 11:677. [PMID: 21878132 PMCID: PMC3175193 DOI: 10.1186/1471-2458-11-677] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 08/31/2011] [Indexed: 12/02/2022] Open
Abstract
Background HIV care providers may be optimally positioned to promote smoking behaviour change in their patients, among whom smoking is both highly prevalent and uniquely harmful. Yet research on this front is scant, particularly in the developing country context. Hence, this study describes smoking behaviour among people living with HIV/AIDS (PLWHA) in the Kathmandu Valley of Nepal, and assesses the association between experience of physician-delivered smoking status assessment and readiness to quit among HIV-positive smokers. Methods We conducted a cross-sectional survey of PLWHA residing in the Kathmandu Valley, Nepal. Data from 321 adult PLWHA were analyzed using multiple logistic regression for correlates of current smoking and, among current smokers, of motivational readiness to quit based on the transtheoretical model (TTM) of behaviour change. Results Overall, 47% of participants were current smokers, with significantly higher rates among men (72%), ever- injecting drug users (IDUs), recent (30-day) alcohol consumers, those without any formal education, and those with higher HIV symptom burdens. Of 151 current smokers, 34% were thinking seriously of quitting within the next 6 months (contemplation or preparation stage of behaviour change). Adjusting for potential confounders, experience of physician-delivered smoking status assessment during any visit to a hospital or clinic in the past 12 months was associated with greater readiness to quit smoking (AOR = 3.34; 95% CI = 1.05,10.61). Conclusions Roughly one-third of HIV-positive smokers residing in the Kathmandu Valley, Nepal, are at the contemplation or preparation stage of smoking behaviour change, with rates significantly higher among those whose physicians have asked about their smoking status during any clinical interaction over the past year. Systematic screening for smoking by physicians during routine HIV care may help to reduce the heavy burden of smoking and smoking-related morbidity and mortality within HIV-positive populations in Nepal and similar settings.
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Affiliation(s)
- Rachel M Amiya
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Manson SM, Jiang L, Zhang L, Beals J, Acton KJ, Roubideaux Y. Special diabetes program for Indians: retention in cardiovascular risk reduction. THE GERONTOLOGIST 2011; 51 Suppl 1:S21-32. [PMID: 21565816 DOI: 10.1093/geront/gnq083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study examined the associations between participant and site characteristics and retention in a multisite cardiovascular disease risk reduction project. DESIGN AND METHODS Data were derived from the Special Diabetes Program for Indians Healthy Heart Demonstration Project, an intervention to reduce cardiovascular risk among American Indians and Alaska Natives with diabetes. In 2006, a total of 1,072 participants from 30 participating sites completed baseline questionnaires measuring demographics and sociobehavioral factors. They also underwent a medical examination at baseline and were reassessed annually after baseline. A Provider Annual Questionnaire was administered to staff members of each grantee site at the end of each year to assess site characteristics. Generalized estimating equation models were used to evaluate the relationships between participant and site characteristics and retention 1 year after baseline. RESULTS Among enrolled participants, 792 (74%) completed their first annual assessment. Participants who completed the first annual assessment tended to be older and had, at baseline, higher body mass index and higher level of physical activity. Site characteristics associated with retention included average age of staff, proportion of female staff members, and percentage of staff members having completed graduate or professional school. IMPLICATIONS Understanding successful retention must reach beyond individual characteristics of participants to include features of the settings that house the interventions.
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Affiliation(s)
- Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Denver, 13055 East 17th Avenue, Mail Stop F800, Aurora, CO 80045.
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Fjalldal SB, Janson C, Benediktsdóttir B, Gudmundsson G, Burney P, Buist AS, Vollmer WM, Gíslason T. Smoking, stages of change and decisional balance in Iceland and Sweden. CLINICAL RESPIRATORY JOURNAL 2011; 5:76-83. [PMID: 21410899 DOI: 10.1111/j.1752-699x.2010.00201.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Smoking remains a significant health problem. Smoking interventions are important but selection of successful quitters can be difficult. OBJECTIVE To characterise smokers with emphasis on two constructs of the transtheoretical model, the stages of change and decisional balance. METHODS A random sample from adults aged 40 and over in Reykjavik, Iceland, and Uppsala, Sweden. Smokers were defined as being in the stage of pre-contemplation (not thinking of quitting within the next 6 months), contemplation (thinking of quitting within the next 6 months) or preparation (thinking of quitting within the next 30 days, having managed to quit for at least 24 h within the last 12 months). RESULTS A total of 226 participants were smokers: 72 (32%) were in the pre-contemplation stage, 126 (56%) in the contemplation stage and 28 (12%) in the preparation stage. A younger age, higher body mass index (BMI) and higher educational level were significantly related to being in a more advanced stage. A significant association was observed between decisional balance and stages of change such that decreased importance of the positive aspects of smoking and increased importance of the negative aspects of smoking were independently associated with an increased readiness to quit. CONCLUSION The motivated smoker is likely to be young and educated with an above average BMI. A smoker in the contemplation stage is likely to maintain the negative aspects of smoking at a high level. Decreasing the value of the pros of smoking may facilitate the shift towards the stage of preparation.
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Affiliation(s)
- Sigrídur B Fjalldal
- Department of Respiratory Medicine, Allergy and Sleep, Landspitali-University Hospital, Iceland
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How is tobacco treatment provided during drug treatment? J Subst Abuse Treat 2011; 42:4-15. [PMID: 21831563 DOI: 10.1016/j.jsat.2011.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 06/13/2011] [Accepted: 06/22/2011] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to obtain descriptions of tobacco treatment services across different substance abuse treatment settings. We conducted mixed-method assessments in eight facilities among eight directors, 25 staff, 29 clients, and 82 client charts. Measures included systems assessment, chart reviews, and semistructured interviews. Although many programs reported they offer key components of evidence-based treatment, few actually provided any treatment and none did so systematically. Many addressed tobacco as part of drug education or part of a health promotion session. Chart reviews suggested that provision of tobacco treatment is rare. By many reports, clients had to specifically request treatment and few staff reported encouraging unmotivated smokers to quit. Systems to facilitate consistent, evidence-based tobacco treatment and to implement quality improvement were nonexistent. The findings imply that drug treatment facilities may need to build capacity in several domains to deliver care that is consistent with national guidelines.
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Do smoking reduction interventions promote cessation in smokers not ready to quit? Addict Behav 2011; 36:764-8. [PMID: 21420791 DOI: 10.1016/j.addbeh.2011.02.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 12/28/2010] [Accepted: 02/08/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Limited treatment options exist for smokers who are not ready to make a quit attempt. Smoking reduction may be a viable treatment approach if proven to increase the rates of long-term abstinence from smoking. METHOD A systematic review of randomized, controlled trials that tested smoking-reduction interventions (pharmacological, behavioral, or both combined) among smokers who were not ready to make a quit attempt (immediately or in the next month) was conducted to assess the efficacy of these strategies in promoting future smoking abstinence. The primary outcome was the 7-day point-prevalence smoking abstinence at longest follow-up (≥6months). Ten trials were included; six tested pharmacologic interventions, one evaluated a behavioral intervention, and three evaluated combined interventions. RESULTS Pharmacologic (2732 participants; OR 2.33, 95% CI 1.43 to 3.79) and combined (638 participants; OR 2.14, 95% CI: 1.28 to 3.60) smoking-reduction interventions significantly increased long-term abstinence from smoking. Insufficient evidence was available on the efficacy of behavioral smoking-reduction interventions (320 participants; OR 1.49, 95% CI 0.56 to 3.93). CONCLUSIONS Further research to evaluate the efficacy of smoking reduction should have cessation as an endpoint, focus on clarity and consistency in patient selection, and identify the mechanism through which nicotine replacement therapy assisted smoking reduction in increasing abstinence rates.
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Tzelepis F, Paul CL, Walsh RA, McElduff P, Knight J. Proactive telephone counseling for smoking cessation: meta-analyses by recruitment channel and methodological quality. J Natl Cancer Inst 2011; 103:922-41. [PMID: 21666098 DOI: 10.1093/jnci/djr169] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Systematic reviews demonstrated that proactive telephone counseling increases smoking cessation rates. However, these reviews did not differentiate studies by recruitment channel, did not adequately assess methodological quality, and combined different measures of abstinence. METHODS Twenty-four randomized controlled trials published before December 31, 2008, included seven of active recruitment, 16 of passive recruitment, and one of mixed recruitment. We rated methodological quality on selection bias, study design, confounders, blinding, data collection methods, withdrawals, and dropouts, according to the Quality Assessment Tool for Quantitative Studies. We conducted random effects meta-analysis to pool the results according to abstinence type and follow-up time for studies overall and segregated by recruitment channel, and methodological quality. The level of statistical heterogeneity was quantified by I(2). All statistical tests were two-sided. RESULTS Methodological quality ratings indicated two strong, 10 moderate, and 12 weak studies. Overall, compared with self-help materials or no intervention control groups, proactive telephone counseling had a statistically significantly greater effect on point prevalence abstinence (nonsmoking at follow-up or abstinent for at least 24 hours, 7 days before follow-up) at 6-9 months (relative risk [RR] = 1.26, 95% confidence interval [CI] = 1.11 to 1.43, P < .001, I(2) = 21.4%) but not at 12-15 months after recruitment. This pattern also emerged when studies were segregated by recruitment channel (active, passive) or methodological quality (strong/moderate, weak). Overall, the positive effect on prolonged/continuous abstinence (abstinent for 3 months or longer before follow-up) was also statistically significantly greater at 6-9 months (RR = 1.58, CI = 1.26 to 1.98, P < .001, I(2) = 49.1%) and 12-18 months after recruitment (RR = 1.40, CI = 1.23 to 1.60, P < .001, I(2) = 18.5%). CONCLUSIONS With the exception of point prevalence abstinence in the long term, these data support previous results showing that proactive telephone counseling has a positive impact on smoking cessation. Proactive telephone counseling increased prolonged/continuous abstinence long term for both actively and passively recruited smokers.
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Affiliation(s)
- Flora Tzelepis
- Centre for Health Research & Psycho-oncology, Cancer Council New South Wales, Faculty of Health, University of Newcastle and Hunter Medical Research Institute, New South Wales, Australia.
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Clair M, Stein L, Martin R, Barnett NP, Colby SM, Monti PM, Golembeske C, Lebeau R. Motivation to change alcohol use and treatment engagement in incarcerated youth. Addict Behav 2011; 36:674-680. [PMID: 21324607 DOI: 10.1016/j.addbeh.2011.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 12/01/2010] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
Abstract
Adolescents have been reported to be less motivated to engage and remain in substance abuse treatment than adults. When they appear motivated, it is often due to external motivators such as family pressure or court mandated treatment. The purpose of this study was to determine if adolescents' motivation to change alcohol use was related to treatment engagement while incarcerated and alcohol use after release. Participants (N=114) were youth in a state correctional facility in the Northeast and included adolescents who engaged in at least monthly drinking. Motivation to change alcohol use was measured by the Alcohol Ladder (AL), and treatment engagement was measured by the Treatment Participation Questionnaire (comprised of positive and negative treatment engagement). Measures were administered at baseline, 2 months in facility follow up, and 3 months post release follow up. Analysis indicated acceptable test-retest stability (r=.388, p≤.001). The AL at 3 months post release significantly predicted quantity and frequency of alcohol use after release. The AL at baseline also significantly predicted positive and negative treatment engagement at 2 months into incarceration (i.e., 2 months in facility follow up) indicating predictive validity. These results suggest that the AL is a reliable, valid, and useful instrument for incarcerated youth.
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Okechukwu CA, Krieger N, Sorensen G, Li Y, Barbeau EM. Testing hypothesized psychosocial mediators: lessons learned in the MassBUILT study. HEALTH EDUCATION & BEHAVIOR 2011; 38:404-11. [PMID: 21474634 DOI: 10.1177/1090198110380544] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Only a few of the interventions that target blue-collar workers have conducted formal analysis to evaluate the specific attributes of their intervention that are associated with success or failure. This study examined the role of dual hazard and decisional balance in the MassBUILT smoking cessation intervention. The authors conducted sets of multivariable linear and logistic regressions that examined if (a) the intervention was associated with changes in the psychosocial variables and (b) increase in psychosocial variables was associated with increase in smoking cessation. As hypothesized by the theoretical basis of the study, higher scores on both of the psychosocial variables were significantly associated with smoking cessation. However, the intervention did not change decisional balance and decreased dual hazard. The variables examined were important but were not mediators of the MassBUILT intervention and this could have contributed to the significant relapse in smoking among study participants.
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Affiliation(s)
- Cassandra A Okechukwu
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA.
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