Group behaviour therapy programmes for smoking cessation

Interventions for tobacco use cessation in people living with HIV

BACKGROUND

The prevalence of tobacco use among people living with HIV (PLWH) is up to four times higher than in the general population. Unfortunately, tobacco use increases the risk of progression to AIDS and death. Individual- and group-level interventions, and system-change interventions that are effective in helping PLWH stop using tobacco can markedly improve the health and quality of life of this population. However, clear evidence to guide policy and practice is lacking, which hinders the integration of tobacco use cessation interventions into routine HIV care. This is an update of a review that was published in 2016. We include 11 new studies.

OBJECTIVES

To assess the benefits, harms and tolerability of interventions for tobacco use cessation among people living with HIV. To compare the benefits, harms and tolerability of interventions for tobacco use cessation that are tailored to the needs of people living with HIV with that of non-tailored cessation interventions.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group's Specialised Register, CENTRAL, MEDLINE, Embase, and PsycINFO in December 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of individual-/group-level behavioural or pharmacological interventions, or both, for tobacco use cessation, delivered directly to PLWH aged 18 years and over, who use tobacco. We also included RCTs, quasi-RCTs, other non-randomised controlled studies (e.g. controlled before and after studies), and interrupted time series studies of system-change interventions for tobacco use cessation among PLWH. For system-change interventions, participants could be PLWH receiving care, or staff working in healthcare settings and providing care to PLWH; but studies where intervention delivery was by research personnel were excluded. For both individual-/group-level interventions, and system-change interventions, any comparator was eligible.

DATA COLLECTION AND ANALYSIS

We followed standard Cochrane methods, and used GRADE to assess certainty of the evidence. The primary measure of benefit was tobacco use cessation at a minimum of six months. Primary measures for harm were adverse events (AEs) and serious adverse events (SAEs). We also measured quit attempts or quit episodes, the receipt of a tobacco use cessation intervention, quality of life, HIV viral load, CD4 count, and the incidence of opportunistic infections.

MAIN RESULTS

We identified 17 studies (16 RCTs and one non-randomised study) with a total of 9959 participants; 11 studies are new to this update. Nine studies contributed to meta-analyses (2741 participants). Fifteen studies evaluated individual-/group-level interventions, and two evaluated system-change interventions. Twelve studies were from the USA, two from Switzerland, and there were single studies for France, Russia and South Africa. All studies focused on cigarette smoking cessation. All studies received funding from independent national- or institutional-level funding. Three studies received study medication free of charge from a pharmaceutical company. Of the 16 RCTs, three were at low risk of bias overall, five were at high risk, and eight were at unclear risk. Behavioural support or system-change interventions versus no or less intensive behavioural support Low-certainty evidence (7 studies, 2314 participants) did not demonstrate a clear benefit for tobacco use cessation rates in PLWH randomised to receive behavioural support compared with brief advice or no intervention: risk ratio (RR) 1.11, 95% confidence interval (CI) 0.87 to 1.42, with no evidence of heterogeneity. Abstinence at six months or more was 10% (n = 108/1121) in the control group and 11% (n = 127/1193) in the intervention group. There was no evidence of an effect on tobacco use cessation on system-change interventions: calling the quitline and transferring the call to the patient whilst they are still in hospital ('warm handoff') versus fax referral (RR 3.18, 95% CI 0.76 to 13.99; 1 study, 25 participants; very low-certainty evidence). None of the studies in this comparison assessed SAE. Pharmacological interventions versus placebo, no intervention, or another pharmacotherapy Moderate-certainty evidence (2 studies, 427 participants) suggested that varenicline may help more PLWH to quit smoking than placebo (RR 1.95, 95% CI 1.05 to 3.62) with no evidence of heterogeneity. Abstinence at six months or more was 7% (n = 14/215) in the placebo control group and 13% (n = 27/212) in the varenicline group. There was no evidence of intervention effects from individual studies on behavioural support plus nicotine replacement therapy (NRT) versus brief advice (RR 8.00, 95% CI 0.51 to 126.67; 15 participants; very low-certainty evidence), behavioural support plus NRT versus behavioural support alone (RR 1.47, 95% CI 0.92 to 2.36; 560 participants; low-certainty evidence), varenicline versus NRT (RR 0.93, 95% CI 0.48 to 1.83; 200 participants; very low-certainty evidence), and cytisine versus NRT (RR 1.18, 95% CI 0.66 to 2.11; 200 participants; very low-certainty evidence). Low-certainty evidence (2 studies, 427 participants) did not detect a difference between varenicline and placebo in the proportion of participants experiencing SAEs (8% (n = 17/212) versus 7% (n = 15/215), respectively; RR 1.14, 95% CI 0.58 to 2.22) with no evidence of heterogeneity. Low-certainty evidence from one study indicated similar SAE rates between behavioural support plus NRT and behavioural support only (1.8% (n = 5/279) versus 1.4% (n = 4/281), respectively; RR 1.26, 95% CI 0.34 to 4.64). No studies assessed SAEs for the following: behavioural support plus NRT versus brief advice; varenicline versus NRT and cytisine versus NRT.

AUTHORS' CONCLUSIONS

There is no clear evidence to support or refute the use of behavioural support over brief advice, one type of behavioural support over another, behavioural support plus NRT over behavioural support alone or brief advice, varenicline over NRT, or cytisine over NRT for tobacco use cessation for six months or more among PLWH. Nor is there clear evidence to support or refute the use of system-change interventions such as warm handoff over fax referral, to increase tobacco use cessation or receipt of cessation interventions among PLWH who use tobacco. However, the results must be considered in the context of the small number of studies included. Varenicline likely helps PLWH to quit smoking for six months or more compared to control. We did not find evidence of difference in SAE rates between varenicline and placebo, although the certainty of the evidence is low.

Effectiveness of smoking cessation interventions among adults: an overview of systematic reviews

BACKGROUND

This overview of reviews aims to identify evidence on the benefits (i.e. tobacco use abstinence and reduction in smoking frequency) and harms (i.e. possible adverse events/outcomes) of smoking cessation interventions among adults aged 18 years and older.

METHODS

We searched Medline, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, the CADTH Health Technology Assessment Database and several other websites for grey literature. Searches were conducted on November 12, 2018, updated on September 24, 2020, with publication years 2008 to 2020. Two reviewers independently performed title-abstract and full-text screening considering pre-determined inclusion criteria. Data extraction and quality assessments were initially completed by two reviewers independently (i.e. 73% of included studies (n = 22)) using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR 2), and the remainder done by one reviewer and verified by another due to resources and feasibility. The application of Grading of Recommendations Assessment, Development and Evaluation (GRADE) was performed by one independent reviewer and verified by another.

RESULTS

A total of 22 Cochrane systematic reviews evaluating the impact of smoking cessation interventions on outcomes such as tobacco use abstinence, reduction in smoking frequency, quality of life and possible adverse events were included. Pharmaceutical (i.e. varenicline, cytisine, nicotine replacement therapy (NRT), bupropion) and behavioural interventions (i.e. physician advice, non-tailored print-based self-help materials, stage-based individual counselling, etc.) showed to have increased smoking cessation; whereas, data for mobile phone-based interventions including text messaging, hypnotherapy, acupuncture, continuous auricular stimulation, laser therapy, electrostimulation, acupressure, St John's wort, S-adenosyl-L-methionine (SAMe), interactive voice response systems and other combination treatments were unclear. Considering harms related to smoking cessation interventions, small/mild harms (i.e. increased palpitations, chest pain, nausea, insomnia, headache) were observed following NRT, varenicline and cytisine use. There were no data on harms related to behavioural therapies (i.e. individual or group counselling self-help materials, internet interventions), combination therapies or other therapies (i.e. laser therapy, electrostimulation, acupressure, St John's wort, SAMe).

CONCLUSION

Results suggest that pharmacological and behavioural interventions may help the general smoking population quit smoking with observed small/mild harms following NRT or varenicline. Consequently, evidence regarding ideal intervention strategies and the long-term impact of these interventions for preventing smoking was unclear.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018099691.

A practical guide for assessing and managing cardiovascular risk during androgen-deprivation therapy in patients with prostate cancer

Prostate cancer is the most common malignancy among men worldwide, and androgen-deprivation therapy (ADT) is a mainstay of treatment. There are observational data demonstrating an increased risk of cardiovascular events in patients who receive ADT, particularly those who have an elevated baseline cardiovascular risk. Because, for most patients with prostate cancer, death is predominantly from noncancer-related causes, cardiovascular disease and its risk factors should be optimized during cancer treatment. This review provides an overview of the landscape of ADT treatment and serves as a guide for appropriate cardiovascular screening and risk-mitigation strategies. The authors emphasize the importance of shared communication between the multidisciplinary cancer team and primary care to improve baseline cardiovascular screening and treatment of modifiable risk factors within this higher risk population.

Systematic review and narrative description of the outcomes of group preoperative education before elective major surgery

Background

Group preoperative education is becoming standard care for patients preparing for surgery, alongside optimisation of exercise, diet, and wellbeing. Although patient education is essential, the effectiveness of group education programmes or 'surgery schools' as a means of delivery is unclear. This review examines whether attending group preoperative education improves patient outcomes.

Methods

We systematically reviewed studies of group perioperative education before major elective surgery. Observational or intervention studies with a baseline group or control arm were included. All outcomes reported were collected and, where possible, effect estimates were summarised using random effects meta-analysis.

Results

Twenty-seven studies reported on 48 different outcomes after group education. Overall, there was a 0.7 (95% confidence interval 0.27-1.13) day reduction in mean length of stay. The odds ratio for postoperative complications after abdominal surgery was 0.56 (95% confidence interval 0.36-0.85; nine studies). Patient-centred outcomes were grouped into themes. Most studies reported a benefit from group education, but only postoperative physical impairment, pain, knowledge, activation, preoperative anxiety, and some elements of quality of life were statistically significant.

Conclusion

This review presents a summary of published evidence available for group preoperative education. While these data lend support for such programmes, there is a need for adequately powered prospective studies to evaluate the effectiveness of preoperative education on clinical outcomes and to evaluate whether behaviour change is sustained. Furthermore, the content, timing and mode of delivery, and evaluation measures of preoperative education require standardisation.

Systematic review protocol

PROSPERO (166297).

Social networks of people with serious mental illness who smoke: potential role in a smoking cessation intervention

BACKGROUND

Smoking is a major contributor to morbidity and mortality among individuals with serious mental illness (SMI) and social networks may play an important role in smoking behaviors.

AIMS

Our objectives were to (1) describe the network characteristics of adults with SMI who smoke tobacco (2) explore whether network attributes were associated with nicotine dependence.

METHODS

We performed a secondary analysis of baseline data from a tobacco smoking cessation intervention trial among 192 participants with SMI. A subgroup (n = 75) completed questions on the characteristics of their social network members. The network characteristics included network composition (e.g. proportion who smoke) and network structure (e.g. density of connections between members). We used multilevel models to examine associations with nicotine dependence.

RESULTS

Participant characteristics included: a mean age 50 years, 49% women, 48% Black, and 41% primary diagnosis of schizophrenia/schizoaffective disorder. The median personal network proportion of active smokers was 22%, active quitters 0%, and non-smokers 53%. The density of ties between actively smoking network members was greater than between non-smoking members (55% vs 43%, p = .02). Proportion of network smokers was not associated with nicotine dependence.

CONCLUSIONS

We identified potential social network challenges and assets to smoking cessation and implications for network interventions among individuals with SMI.

Monday-Enhanced CEASE Program for Underserved Ethnic Minorities: a Mixed-Methods Study

BACKGROUND

Due to the persistence of tobacco-related health disparities in the U.S., there is a need for innovative strategies to reach the underserved ethnic minority populations who are most at risk. As contemplations for health behavior modification tend to surge on Mondays, we explored the feasibility and effect of a Monday-enhanced smoking cessation program on quitting outcomes in a low-income ethnic minority community.

AIMS

To compare a Monday-enhanced with a standard Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program and understand the overall experiences of participants in the program.

METHODS

In this mixed-methods study, affordable housing complexes (n = 4) and a church were randomly assigned either a Monday-enhanced (n = 3) or standard (n = 2) CEASE smoking cessation program. CEASE comprised twelve weekly group counseling sessions facilitated by trained peer motivators plus nicotine replacement products. Participants in the Monday-enhanced arm were encouraged to pick Mondays as a quitting day. Quantitative and qualitative data were collected during the program and at 3-month post-graduation.

RESULTS

Seventy-seven participants were enrolled in the study arms. In both groups combined, tobacco consumption reduced from 7.7 to 5.6 cig/day (mean reduction, 2.1; 95% CI: 0.9 to 5.1, p = 0.08). Although no significant difference in quit rate was observed between the two arms, more participants completed the follow-up survey in the Monday-enhanced than standard CEASE program [82.4% vs. 36.0%, p < 0.05]. While qualitative data suggested an overall satisfaction of participants with the program, motivation for quitting was higher in the Monday-enhanced CEASE program compared to the standard CEASE program.

CONCLUSION

The Monday-enhanced program is promising and may enhance participants' engagement and willingness to quit smoking, particularly in low-income ethnic minority communities. Further research should include larger sample sizes to better assess the efficacy of a Monday-enhanced program across diverse populations.

How a 5-Day Stay in the Tobacco-Free Environment of the Stoptober House Supports Individuals to Quit Smoking: A Mixed Methods Pilot Study

INTRODUCTION

The Stoptober House is part of the annual national Stoptober smoking cessation campaign in the Netherlands. During the first week of October, 48 volunteers resided in the tobacco-free Stoptober House for 5 days and received smoking cessation counseling. This pilot study explored how the Stoptober House may have facilitated smoking cessation among participants.

METHODS

We included 48 individuals who were selected for the Stoptober House (intervention group) and 67 individuals who were not selected (control group). Surveys were conducted at baseline, immediately after 2 and 8 weeks of post-intervention. We compared self-reported abstinence, psychosocial mediators related to smoking cessation, and perceived active elements of the Stoptober House between the intervention and control groups using t/χ2 tests and linear mixed model (LMM) analysis. Sixteen semi-structured qualitative interviews were conducted to explore participants' perspectives on the elements contributing to their success in quitting smoking.

RESULTS

At 8 weeks of follow-up, a higher proportion of participants in the intervention group (24/48 [50%]) reported being abstinent compared to the control group (5/67 [7%]; p < 0.001). Among participants who reported making a quit attempt, 22/38 (57.9%) in the intervention group remained abstinent compared to 4/17 (23.5%) in the control group (p = 0.022). The intervention group also exhibited higher self-efficacy to quit smoking throughout the follow-up period and higher social support immediately after the Stoptober House. No significant differences were observed in other psychosocial factors. The interviews highlighted several perceived elements of the Stoptober House that contributed to smoking cessation success, including restricted smoking opportunities, access to smoking cessation counselors, and peer support.

CONCLUSION

This pilot study suggests that the Stoptober House provides support that can help people quit smoking. Further research is needed to confirm these findings and determine the cost-effectiveness of this intervention in promoting long-term abstinence among specific groups of smokers.

Preliminary Efficacy of a Cognitive Behavioral Therapy-Based Smartphone App for Smoking Cessation in China: Randomized Controlled Pilot Trial

BACKGROUND

The overall prevalence of cigarette smokers in China is very high, and China's total cigarette consumption makes up more than 40% of the world's consumption. In view of the lack of smoking cessation services and social support in China and the effectiveness of mobile phone apps for quitting smoking in other countries, we carried out a smartphone app-based smoking cessation trial in China.

OBJECTIVE

This study aimed to evaluate the efficacy of a cognitive behavioral therapy (CBT)-based smoking cessation smartphone app among smokers seeking treatment in China.

METHODS

We conducted a randomized controlled, web-based pilot clinical trial in China between February 23 and June 27, 2021. Eligible participants were randomly assigned to the smoking cessation app intervention group or the control group in a ratio of 1:1. The intervention group received the CBT smoking cessation intervention using a smartphone app, and the control group received a "thank you" message. The intervention was 4 weeks long, and the patients were followed up for 4 weeks. The primary outcome was self-reported continuous smoking abstinence at week 4 after the quit date. The secondary outcomes included self-reported 7-day point prevalence of smoking abstinence; reduction of the number of cigarettes smoked per day at weeks 1, 2, 3, and 4; and program acceptability.

RESULTS

A total of 973 people were recruited to quit smoking, of whom 262 completed basic information, 56 were excluded, and 206 were randomized and included in the final analysis. There were 189 (91.7%) men and 17 (8.3%) women, with an average age of 34.46 (SD 7.53) years and an average daily smoking rate of 15.93 (SD 7.10) cigarettes/day. We found 30 (29.7%) of the 101 participants in the intervention group and 7 (6.7%) of the 105 participants in the control group reported continuous smoking cessation after the quit date at week 4 (odds ratio 5.92, 95% CI 3.78-9.26; P<.001). The 7-day point prevalence abstinence rate of the intervention group varied from 42.6% (43/101) to 46.5% (47/101) after 1, 2, 3, and 4 weeks, while the control group varied from 18.1% (19/105) to 26.7% (28/105). Compared to the control group, continued smokers consumed 1.5-3.0 fewer cigarettes per day in the intervention group. The overall program got positive user feedback with a high satisfaction rate (66/87, 76%) and an average Mobile Application Rating Scale user version score of 3.46.

CONCLUSIONS

Our pilot study provided preliminary evidence that the CBT-based smoking cessation smartphone app led to improved smoking quit rates versus control in Chinese smokers. The study demonstrated the CBT-based smartphone app may be an effective and feasible digital treatment model to help smokers quit, which may improve smoking cessation service quality and accessibility in China.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04421170; https://clinicaltrials.gov/study/NCT04421170.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2020-041985.

The feasibility and efficacy of the group-based therapy for smoking cessation in Klang Valley, Malaysia

INTRODUCTION

Tobacco epidemic is a global public health concern, killing more than 8 million people annually. Individual therapy is the standard of care of behavioral intervention for smoking cessation in Malaysia and group-based therapy for smoking cessation is an alternative to behavioral intervention commonly used in the western population effectively. The study explored the feasibility and efficacy of group-based therapy for smoking cessation for smokers who want to quit smoking at a quit smoking clinic and community centers in an urban setting in Malaysia.

METHODS

A total of 40 participants who were active smokers and fulfilled the criteria were recruited for the study at the quit smoking clinic. Participants were given behavioral support based on the GBT-M module and individually for 7 weeks with both groups receiving behavioral intervention plus pharmacotherapy.

RESULTS

The median age of participants was 48 years for individual therapy and 45 years for group therapy. Group-based therapy was comparable to individual therapy in smoking abstinence outcome at 4 weeks post quit date (35% vs 30%).

CONCLUSIONS

Group-based therapy was equally effective compared to individual therapy, similar to the western population. Using a group format should allow more people to be treated by a therapist, and therefore could be more cost-effective. Group-based therapy is an option to be included as part of the smoking cessation program in Malaysia.

Hypnotherapy compared to cognitive-behavioral therapy for smoking cessation in a randomized controlled trial

Worldwide, more than eight million people die each year as a result of tobacco use. A large proportion of smokers who want to quit are interested in alternative smoking cessation methods, of which hypnotherapy is the most popular. However, the efficacy of hypnotherapy as a tobacco cessation intervention cannot be considered sufficiently proven due to significant methodological limitations in the studies available to date. The aim of the present study was to compare the efficacy of a hypnotherapeutic group program for smoking cessation with that of an established cognitive-behavioral group program in a randomized controlled trial. A total of 360 smokers who were willing to quit were randomly assigned to either hypnotherapy (HT) or cognitive-behavioral therapy (CBT) at two study sites, without regard to treatment preference. They each underwent a 6 weeks smoking cessation course (one 90 min group session per week) and were followed up at regular intervals over a 12 months period. The primary outcome variable was defined as continuous abstinence from smoking according to the Russell standard, verified by a carbon monoxide measurement at three measurement time points. Secondary outcome variables were 7 days point prevalence abstinence during the 12 months follow up and the number of cigarettes the non-quitters smoked per smoking day (smoking intensity). Generalized estimating equations were used to test treatment condition, hypnotic suggestibility, and treatment expectancy as predictors of abstinence. The two interventions did not differ significantly in the proportion of participants who remained continuously abstinent throughout the follow-up period (CBT: 15.6%, HT: 15.0%) and also regarding the 7 days abstinence rates during the 12 months follow-up (CBT: 21.2%, HT: 16.7%). However, when controlling for hypnotic suggestibility, CBT showed significantly higher 7 days abstinence rates. In terms of the continuous abstinence rates, it can be concluded that the efficacy of hypnotherapeutic methods for smoking cessation seem to be comparable to established programs such as CBT.

Clinical trial registration

ClinicalTrials.gov, identifier NCT01129999.

Short-term effectiveness of the national German quitline for smoking cessation: results of a randomized controlled trial

BACKGROUND

The objective of the present study was to examine the short-term effectiveness of the national German quitline for smoking cessation.

METHODS

A parallel-group, two-arm, superiority, randomized controlled trial with data collection at baseline and post-intervention (three months from baseline) was conducted. Individuals were randomized to either the intervention group, receiving up to six telephone counselling calls, or the control group, receiving an active control intervention (self-help brochure). The primary outcome was the seven-day point prevalence abstinence at post-assessment. Secondary outcomes included changes in smoking-related cognitions and coping strategies from pre- to post-assessment, the perceived effectiveness of intervention components, and the satisfaction with the intervention.

RESULTS

A total of n = 905 adult daily smokers were assigned to either the intervention group (n = 477) or the control group (n = 428). Intention-to-treat analyses demonstrated that individuals allocated to the telephone counselling condition were more likely to achieve seven-day point prevalence abstinence at post-assessment compared to those allocated to the self-help brochure condition (41.1% vs. 23.1%; OR = 2.3, 95% CI [1.7, 3.1]). Participants who received the allocated intervention in both study groups displayed significant improvements in smoking-related cognitions and coping strategies with the intervention group showing greater enhancements than the control group. This pattern was also found regarding the perceived effectiveness of intervention components and the satisfaction with the intervention.

CONCLUSION

The present study provides first empirical evidence on the short-term effectiveness of the national German quitline for smoking cessation, highlighting its potential as an effective public health intervention to reduce the burden of disease associated with smoking.

TRIAL REGISTRATION

This study is registered in the German Clinical Trials Register (DRKS00025343). Date of registration: 2021/06/07.

A phone-based tobacco use cessation program for people living with HIV in Uganda and Zambia: study protocol for a randomized controlled trial

BACKGROUND

Nicotine replacement therapy (NRT) and short messaging service (SMS)-based tobacco cessation interventions have demonstrated effectiveness in reducing tobacco use in many populations, but evidence is needed on which tailored treatments are most efficacious in meeting the complex medical and psychosocial factors confronting people living with HIV (PLWH) in sub-Saharan Africa (SSA). This paper describes the protocol of a study to test the efficacy of both NRT and a tailored SMS-based tobacco use cessation intervention among PLWH in Uganda and Zambia.

METHODS

In a randomized controlled trial, 800 adult PLWH who use tobacco will be recruited by health care professionals at HIV treatment centers where they are receiving care. Participants will be randomized to one of the four study arms: (1) standard of care [SOC; brief clinician advice to quit combined with HIV education and information aimed at encouraging HIV treatment adherence (with no mention of tobacco) delivered via text messages]; (2) SOC + 12 weeks of NRT; (3) SOC + 6 weeks of SMS text messages to support quitting tobacco use (SMS); or (4) SOC + NRT + SMS. Participants will receive a cell phone and solar panel with power bank for charging the phone. The main outcome is cessation of tobacco use by study participants verified by urinary cotinine (< 15 ng/mL) at 6 months post-enrollment. As a secondary tobacco use outcome, we will measure 7-day point-prevalence abstinence (7 consecutive days of no tobacco use) measured by self-report and biochemically-verified at 4 weeks, 8 weeks, and 3 months post enrollment.

DISCUSSION

Our study will provide insight into the efficacy, feasibility and applicability of delivering tobacco cessation interventions through health care professionals combined with tailored tobacco cessation SMS text messaging in two countries with different tobacco use patterns, policy environments, and health care resources and provide needed information to providers and policymakers looking for cost-effective tobacco cessation interventions. The previously tested SMS-platform to be used in our study is uniquely positioned to be scaled in low- and middle-income countries worldwide, in which case evidence of even modest success in reducing the prevalence of tobacco consumption among PLWH could confer enormous health and economic benefits.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT05487807. Registered August 4, 2022, https://clinicaltrials.gov/ct2/show/record/NCT05487807.

Experiences with smoking habits and the need for cessation among habitual smokers in Japan: a qualitative study based on semi-structured interviews

BACKGROUND

Although more than half of the habitual smokers recognize that they want to quit smoking cigarettes, approximately half have failed to quit and experienced distress relapse; therefore, there is an urgent need to focus on these populations. When chronic behavior occurs, it is necessary to view the behavior in the context of the entire life of the person involved, considering the history of the person. In this study, we aimed to describe experiences with smoking from the onset to the present and the need for smoking cessation among habitual smokers in Japan and to explore efforts to address them.

METHODS

Semi-structured interviews that lasted for 55-90 min were conducted with the cooperation of 16 habitual smokers who smoked cigarettes daily. The content of the interviews included demographic characteristics, experiences with smoking from the onset to the present, whether they have attempted to quit and related experiences, and their thoughts on smoking. Interviews were transcribed verbatim and analyzed qualitatively. The Medical Research Ethics Review Committee of Jikei University approved this study (approval number: 33-384(11008)).

RESULTS

The participants were aged 26-59 years (mean ± SD: 40.8 ± 8.9 years) and included 10 men and 6 women. The participants started smoking between age 13 and 24 years. The highest number of cigarettes smoked in the participants' lives ranged from 10 to 80 daily, and 12 participants had attempted to quit smoking so far without success. Regarding experiences with smoking from the onset to the present, four themes of "expand one's world," "unconscious attachment," "attempts and failures," and "losing oneself" were extracted. Regarding the need for smoking cessation, four themes of "empowerment from experts," "peer interaction," "social commitment," and "recovery of confidence" were extracted.

CONCLUSION

To support smoking cessation from the perspective of habitual smokers, in addition to improvements through the existing approaches, it is important to recover their confidence using ongoing activities in peer groups according to the target background and support from experts incorporating visual assessments of lung function, along with multiple short-term goals. It is also necessary to raise awareness in communities through activities.

Smoking cessation attempts and successes among Nunavimmiut

OBJECTIVES

The smoking rate in Canada has declined in past decades, yet smoking rates remain high in Nunavik (northern Québec), where an estimated 80% of adult respondents smoke. We investigated sociodemographic factors, smoking behaviours, harm perception, and social support as determinants of smoking cessation attempts and successes among Nunavimmiut.

METHODS

Past year smoking frequency, quantity smoked, and cessation attempts and aids were documented in a sample of 1326 Nunavimmiut aged 16 and over in the Qanuilirpitaa? 2017 survey. Sociodemographic indicators, social support, cessation aids, and smoking harm perception were investigated as potential determinants. All factors were modeled by logistic regressions and adjusted for age and sex.

RESULTS

Thirty-nine percent of smokers tried to quit smoking in the preceding year, and 6% of those were successful. Older Nunavimmiut (aOR = 0.84 [0.78, 0.90]) and those smoking 20 + cigarettes/day (aOR = 0.94 [0.90, 0.98]) were less likely to attempt to quit. Ungava coast residents (aOR = 1.87 [1.36, 2.57]), separated/widowed/divorced individuals (aOR = 2.43 [1.09, 5.38]), and occasional smokers (aOR = 2.77 [1.61, 4.76]) compared to those living on the Hudson coast, single individuals, and daily smokers, respectively, were more likely to report cessation attempts. Most used no particular cessation aid (58%), 28% relied on family/self-help/support programs, and 26% used medication. Women were more likely to rely on spirituality/traditional methods (aOR = 1.92 [1.00, 3.71]) and less likely to rely on electronic cigarettes (aOR = 0.33 [0.13, 0.84]), as were older participants (aOR = 0.67 [0.49, 0.94]). Those with more years of schooling were more likely to rely on electronic cigarettes (aOR = 1.47 [1.06, 2.02]). These estimates are prone to biases due to the relatively low participation rate in the survey (37%).

CONCLUSION

Despite many attempts reported by participants, regional partners of this study underlined that successful smoking cessation remains a challenge for many Nunavimmiut. Key differences were identified in approaches and determinants of smoking cessation attempts, but most smokers did not use cessation aids. These results are in line with the experience of the Inuit partners of this study and can inform targeted public health interventions to support the many Nunavimmiut trying to quit smoking, notably increasing accessibility and acceptability of cessation aids. Inuit partners of this study highlighted the importance for interventions and communication efforts to reflect Nunavik's context.

Evidence from a Smoking Management Service in a University Teaching Hospital in Dublin, Ireland monitored by repeat surveys, 1997-2022

St Vincent's University Hospital (SVUH) has a comprehensive smoking management programme and since 1997 has conducted periodic surveys of inpatients, outpatients, staff and visitors to establish prevalence of smoking and associated attitudes towards the hospital's smoke-free campus policy pioneered in 2009. We report trends and describe also the online community stop smoking course (SSC) developed more recently in response to COVID-19. A questionnaire examining attitudes and smoking status was administered by census surveys of inpatients, quota or random sub-sample surveys of staff, and quota surveys with outpatients and visitors in the time period of 1997-2018. Chi square test for trend was used. Smoking rates declined in all groups but significantly so in outpatients (19.5% vs. 10%; p < 0.01), visitors (27.4% vs. 9.5%; p < 0.0001) and staff (30.0% vs. 10.8%; p < 0.0001). Use of E-Cigarettes was low in all cohorts. Rates of smoking were borderline higher in inpatients eligible by income for state-funded General Medical Services (33.2% vs 26.8%, p = 0.099). Support for and awareness of the ban increased over time. Demographic and quit data was compared between participants of in-person or online SSC. The online courses were successful with a maintenance of quit rates (End of Course: 54.7% vs. 55.0%, 1 Month: 50.4% vs. 54.0%, 3 Month: 19.8% vs. 22.5%). While the hospital community's smoking prevalence has decreased over time and attitudes to the smoking ban have been increasingly positive, the campus is not without difficulties in keeping it smoke-free. We continue to advocate for hospital staff support in enacting this flagship initiative.

"Boy, what are we all doing? We are crazy, really crazy": a qualitative study of psychosocial processes around an atypical one-time smoking cessation course

BACKGROUND

Smoking prevalence is still high, which requires effective interventions that help many people who smoke at once in addition to time-consuming individual interventions. 'I Quit' is a large-scale smoking cessation course in The Netherlands. This qualitative study explored I Quit participants' experiences during and after the course, and perceptions of whether and how the course may have altered their smoking behavior.

METHODS

We performed individual semi-structured interviews with course participants (N = 21) who had either quit successfully, attempted to quit but relapsed, or had continued to smoke after 'I Quit'. Shortly after qualitative data collection was completed, Foundation I Quit was accused in the media of a number of misbehaviors. Although unplanned, this provided a unique opportunity to explore participants' views on alleged fraud in a second round of interviews (N = 16). Data were collected from 2016 to 2018.

RESULTS

Qualitative findings showed two psychosocial processes that may explain smoking cessation after course attendance. First, the confrontation with a large group of people who smoke, of whom some had already developed smoking-related complaints, triggered identity processes both towards and away from quitting smoking. Unorthodox methods used in the course appeared to trigger identity processes. Second, social support after the course from participants' own social network facilitated maintenance of successful quitting. The study also found that interview participants' opinions on I Quit did not change much after allegations of fraud in the media.

CONCLUSIONS

Findings suggest that a one-time course might initiate psychosocial processes that could help certain smokers to gain motivation to quit, requiring a minimum of resources. Identity processes triggered by the course seem tricky as people have different ways of dealing with identity threat, some of which can be counterproductive and even result in more difficulty quitting. More research is needed to examine who can benefit from a one-time course, and who needs more support in order to quit successfully.

Smoking cessation and relapse-prevention interventions tailored for expectant and new fathers: protocol of a systematic review and network meta-analysis

INTRODUCTION

Exposure of pregnant women and newborns to secondhand smoke (SHS) can lead to adverse maternal and neonatal health outcomes. Among expectant and new fathers, who are the main source of SHS exposure for pregnant women, new mothers and babies, smoking rates remain high. A partner's pregnancy potentially constitutes a critical period where expectant and new fathers are motivated to quit smoking. However, there is no consensus on the optimal form and delivery of smoking cessation and relapse-prevention interventions. We present a systematic review and network meta-analysis protocol that aims to synthesise and evaluate the effectiveness of smoking cessation and relapse-prevention interventions tailored for this population.

METHODS AND ANALYSIS

To identify relevant studies, we will conduct a comprehensive search, in English and Chinese, of 10 electronic databases. The review will include randomised and quasi-randomised controlled trials that compare behavioural interventions (tailored and non-tailored) with/without the addition of pharmacotherapy with usual care, a minimal or placebo control for assisting expectant and new fathers to quit smoking and prevent smoking relapse. The primary outcome of interest is the self-reported and/or biochemically verified smoking abstinence at ≥1-month follow-up. Two reviewers will independently screen, select and extract relevant studies, and perform a quality assessment. Disagreements will be resolved by a consensus or third-party adjudication. The Cochrane Risk of Bias tool V.2 will be used to assess the risk of bias in the included studies. We will obtain the results of the systematic review through pooled quantitative analyses using a network meta-analysis. Sensitivity and subgroup analyses will be performed.

ETHICS AND DISSEMINATION

Ethical approval is not required for this systematic review of published data. The findings will be disseminated via peer-reviewed publication.

PROSPERO REGISTRATION NUMBER

CRD42022340617.

Estimating the true effectiveness of smoking cessation interventions under variable comparator conditions: A systematic review and meta-regression

BACKGROUND AND AIMS

Behavioural smoking cessation trials have used comparators that vary considerably between trials. Although some previous meta-analyses made attempts to account for variability in comparators, these relied on subsets of trials and incomplete data on comparators. This study aimed to estimate the relative effectiveness of (individual) smoking cessation interventions while accounting for variability in comparators using comprehensive data on experimental and comparator interventions.

METHODS

A systematic review and meta-regression was conducted including 172 randomised controlled trials with at least 6 months follow-up and biochemically verified smoking cessation. Authors were contacted to obtain unpublished information. This information was coded in terms of active content and attributes of the study population and methods. Meta-regression was used to create a model predicting smoking cessation outcomes. This model was used to re-estimate intervention effects, as if all interventions have been evaluated against the same comparators. Outcome measures included log odds of smoking cessation for the meta-regression models and smoking cessation differences and ratios to compare relative effectiveness.

RESULTS

The meta-regression model predicted smoking cessation rates well (pseudo R2  = 0.44). Standardising the comparator had substantial impact on conclusions regarding the (relative) effectiveness of trials and types of intervention. Compared with a 'no support comparator', self-help was 1.33 times (95% CI = 1.16-1.49), brief physician advice 1.61 times (95% CI = 1.31-1.90), nurse individual counselling 1.76 times (95% CI = 1.62-1.90), psychologist individual counselling 2.04 times (95% CI = 1.95-2.15) and group psychologist interventions 2.06 times (95% CI = 1.92-2.20) more effective. Notably, more elaborate experimental interventions (e.g. psychologist counselling) were typically compared with more elaborate comparators, masking their effectiveness.

CONCLUSIONS

Comparator variability and underreporting of comparators obscures the interpretation, comparison and generalisability of behavioural smoking cessation trials. Comparator variability should, therefore, be taken into account when interpreting and synthesising evidence from trials. Otherwise, policymakers, practitioners and researchers may draw incorrect conclusions about the (cost) effectiveness of smoking cessation interventions and their constituent components.

Non-pharmacological interventions for smoking cessation: analysis of systematic reviews and meta-analyses

BACKGROUND

Although non-pharmacological smoking cessation measures have been widely used among smokers, current research evidence on the effects of smoking cessation is inconsistent and of mixed quality. Moreover, there is a lack of comprehensive evidence synthesis. This study seeks to systematically identify, describe, and evaluate the available evidence for non-pharmacological interventions in smoking populations through evidence mapping (EM), and to search for best-practice smoking cessation programs.

METHODS

A comprehensive search for relevant studies published from the establishment of the library to January 8, 2023, was conducted in PubMed, Web of Science, Embase, the Cochrane Library, CNKI, CBM, Wan Fang, and VIP. Two authors independently assessed eligibility and extracted data. The PRISMA statement and AMSTAR 2 tool were used to evaluate the report quality and methodology quality of systematic reviews/meta-analyses (SRs/MAs), respectively. Bubble plots were utilized to display information, such as the study population, intervention type, evidence quality, and original study sample size.

RESULTS

A total of 145 SRs/MAs regarding non-pharmacological interventions for smoking cessation were investigated, with 20 types of interventions identified. The most commonly used interventions were cognitive behaviour education (n = 32, 22.07%), professional counselling (n = 20, 13.79%), and non-nicotine electronic cigarettes (e-cigarettes) (n = 13, 8.97%). Among them, counselling and behavioural support can improve smoking cessation rates, but the effect varies depending on the characteristics of the support provided. These findings are consistent with previous SRs/MAs. The general population (n = 108, 74.48%) was the main cohort included in the SRs/MAs. The total score of PRISMA for the quality of the reports ranged from 8 to 27, and 13 studies (8.97%) were rated as high confidence, and nine studies (6.21%) as moderate confidence, in the AMSTAR 2 confidence rating.

CONCLUSIONS

The abstinence effect of cognitive behaviour education and money incentive intervention has advantages, and non-nicotine e-cigarettes appear to help some smokers transition to less harmful replacement tools. However, the methodological shortcomings of SRs/MAs should be considered. Therefore, to better guide future practice in the field of non-pharmacological smoking cessation, it is essential to improve the methodological quality of SRs and carry out high-quality randomized controlled trials (RCTs).

Comparison of in-person versus telephonic interview on tobacco cessation in an Indian dental setting

Oral health professionals in the dental office settings have a distinctive opportunity to increase tobacco abstinence rates among tobacco users as tobacco use has significant adverse effects on oral health. This review assesses the effectiveness of tobacco cessation interventions offered to cigarette smokers and smokeless tobacco users in the dental office setting. The following electronic retrieval systems and databases were searched for the identification of studies, The Cochrane Central Register of Controlled Trials, PUBMED, GOOGLE SCHOLAR, SCIENCE DIRECT and TRIP. The review included randomized clinical trials assessing tobacco cessation interventions conducted by oral health professionals in the dental office setting. Seven clinical trials met the criteria for inclusion in this review. All the studies have employed behavioral therapy, telephonic counseling's and pharmacotherapy as interventional component. The rate of abstinence and biochemical validation were the outcome measurements. Since all the studies included were randomized clinical trials, the level of evidence was II. Available evidence suggests that telephonic interventions for tobacco use conducted by oral health professionals in the dental office setting may increase tobacco abstinence rates among smokers and smokeless tobacco users. This review data suggests that telephone has a pragmatic effect on interactional aspects of psychological therapy. Further research should be carried out to make conclusive recommendations regarding the intervention components that can be incorporated in the dental office settings.

Interventions for waterpipe smoking cessation

BACKGROUND

While cigarette smoking has declined globally, waterpipe smoking is rising, especially among youth. The impact of this rise is amplified by mounting evidence of its addictive and harmful nature. Waterpipe smoking is influenced by multiple factors, including appealing flavors, marketing, use in social settings, and misperceptions that waterpipe is less harmful or addictive than cigarettes. People who use waterpipes are interested in quitting, but are often unsuccessful at doing so on their own. Therefore, developing and testing waterpipe cessation interventions to help people quit was identified as a priority for global tobacco control efforts.  OBJECTIVES: To evaluate the effectiveness of tobacco cessation interventions for people who smoke waterpipes.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Review Group Specialized Register from database inception to 29 July 2022, using variant terms and spellings ('waterpipe' or 'narghile' or 'arghile' or 'shisha' or 'goza' or 'narkeela' or 'hookah' or 'hubble bubble'). We searched for trials, published or unpublished, in any language.

SELECTION CRITERIA

We sought randomized controlled trials (RCTs), quasi-RCTs, or cluster-RCTs of any smoking cessation interventions for people who use waterpipes, of any age or gender. In order to be included, studies had to measure waterpipe abstinence at a three-month follow-up or longer.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcome was abstinence from waterpipe use at least three months after baseline. We also collected data on adverse events. Individual study effects and pooled effects were summarized as risk ratios (RR) and 95% confidence intervals (95% CI), using Mantel-Haenszel random-effects models to combine studies, where appropriate. We assessed statistical heterogeneity with the I2 statistic. We summarized secondary outcomes narratively. We used the five GRADE considerations (risk of bias, inconsistency of effect, imprecision, indirectness, and publication bias) to assess the certainty of the body of evidence for our primary outcome in four categories high, moderate, low, or very low.

MAIN RESULTS

This review included nine studies, involving 2841 participants. All studies were conducted in adults, and were carried out in Iran, Vietnam, Syria, Lebanon, Egypt, Pakistan, and the USA. Studies were conducted in several settings, including colleges/universities, community healthcare centers, tuberculosis hospitals, and cancer treatment centers, while two studies tested e-health interventions (online web-based educational intervention, text message intervention). Overall, we judged three studies to be at low risk of bias, and six studies at high risk of bias. We pooled data from five studies (1030 participants) that tested intensive face-to-face behavioral interventions compared with brief behavioral intervention (e.g. one behavioral counseling session), usual care (e.g. self-help materials), or no intervention. In our meta-analysis, we included people who used waterpipe exclusively, or with another form of tobacco. Overall, we found low-certainty evidence of a benefit of behavioral support for waterpipe abstinence (RR 3.19 95% CI 2.17 to 4.69; I2 = 41%; 5 studies, N = 1030). We downgraded the evidence because of imprecision and risk of bias. We pooled data from two studies (N = 662 participants) that tested varenicline combined with behavioral intervention compared with placebo combined with behavioral intervention. Although the point estimate favored varenicline, 95% CIs were imprecise, and incorporated the potential for no difference and lower quit rates in the varenicline groups, as well as a benefit as large as that found in cigarette smoking cessation (RR 1.24, 95% CI 0.69 to 2.24; I2 = 0%; 2 studies, N = 662; low-certainty evidence). We downgraded the evidence because of imprecision. We found no clear evidence of a difference in the number of participants experiencing adverse events (RR 0.98, 95% CI 0.67 to 1.44; I2 = 31%; 2 studies, N = 662). The studies did not report serious adverse events.   One study tested the efficacy of seven weeks of bupropion therapy combined with behavioral intervention. There was no clear evidence of benefit for waterpipe cessation when compared with behavioral support alone (RR 0.77, 95% CI 0.42 to 1.41; 1 study, N = 121; very low-certainty evidence), or with self-help (RR 1.94, 95% CI 0.94 to 4.00; 1 study, N = 86; very low-certainty evidence).  Two studies tested e-health interventions. One study reported higher waterpipe quit rates among participants randomized to either a tailored mobile phone or untailored mobile phone intervention compared with those randomized to no intervention (RR 1.48, 95% CI 1.07 to 2.05; 2 studies, N = 319; very low-certainty evidence). Another study reported higher waterpipe abstinence rates following an intensive online educational intervention compared with a brief online educational intervention (RR 1.86, 95% CI 1.08 to 3.21; 1 study, N = 70; very low-certainty evidence).  AUTHORS' CONCLUSIONS: We found low-certainty evidence that behavioral waterpipe cessation interventions can increase waterpipe quit rates among waterpipe smokers. We found insufficient evidence to assess whether varenicline or bupropion increased waterpipe abstinence; available evidence is compatible with effect sizes similar to those seen for cigarette smoking cessation.  Given e-health interventions' potential reach and effectiveness for waterpipe cessation, trials with large samples and long follow-up periods are needed. Future studies should use biochemical validation of abstinence to prevent the risk of detection bias. Finally, there has been limited attention given to high-risk groups for waterpipe smoking, such as youth, young adults, pregnant women, and dual or poly tobacco users. These groups would benefit from targeted studies.

Participation of Primary Care Nurses in the Prevention of Chronic Non-Communicable Diseases in the Republic of Kazakhstan: A Cross-Sectional Study

Background

Chronic diseases are a huge threat to public health in Kazakhstan and around the world. Many deaths can be prevented by using evidence-based behavioral interventions. Nurses, as the most numerous health care workers, can perform behavioral therapy for the prevention of Non-Communicable Diseases (NCDs). This study was conducted in order to explore the behavioral interventions performed by nurses, to analyze current problems, barriers and the attitude of nurses to these activities.

Materials and Methods

A cross-sectional study was conducted among 260 nurses in the city of Nur-Sultan from 2019 to 2020. The sample was calculated using a formula and simple random sampling. The study was conducted using a specially compiled questionnaire. Descriptive statistics were chosen as a statistical method. Pearson's Chi-square criterion was used to identify a statistically significant relationship between variables.

Results

Among 260 nurses, 208 participants (80%) had the desire to conduct behavioral interventions among patients. Most nurses do not have enough time to conduct behavioral interventions. A short work experience affects to a greater extent nurses use passive training methods. Almost half (47.30%) of nurses rate their level of knowledge about the real effects of drugs, tobacco, alcohol, and preventive measures on the body as "average".

Conclusions

The work of nurses on the prevention of NCDs is not performed enough due to lack of working time and available domestic literature, heavy workload. Behavioral therapy should be based on reliable scientific evidence, which can be achieved through the development of clinical guidelines and continuous training of nurses.

Evaluation of an innovative mHealth-based integrated modality for smoking cessation in Chinese smokers: protocol for a randomized controlled trial

BACKGROUND AND AIMS

Developing accessible, affordable, and effective approaches to smoking cessation is crucial for tobacco control. Mobile health (mHealth) based interventions have the potential to aid smokers in quitting, and integrating treatments from multiple sources may further enhance their accessibility and effectiveness. As part of our efforts in smoking cessation, we developed a novel behavioral intervention delivery modality for smoking cessation that integrated three interventions using the WeChat app, called the "Way to Quit" modality (WQ modality). It is presented here the protocol for a randomized controlled trial evaluating the effectiveness, feasibility, and cost-effectiveness of the WQ modality in Chinese smokers.

METHODS

Eligible participants (n = 460) will be recruited via online advertisement in Beijing, China. They will be randomly assigned to receive either quitline-based treatment (QT, n = 230) or WQ modality-based treatment (WQ, n = 230) using a block randomization method. Participants in the QT group will receive telephone-assisted treatment over a four-week period (multi-call quitline protocol), while those in the WQ group will receive integrated interventions based on the WQ modality for four weeks. A four-week supply of nicotine replacement therapy (gums) will be provided to all participants. Participants will be asked to complete phone or online follow-up at 1, 3, 6, and 12-months. At 1-month follow-up, individuals with self-reported smoking abstinence for more than 7 days will be invited to receive an exhaled carbon monoxide (CO) test for biochemical validation. The primary aim is to determine whether the WQ modality is effective in assisting smokers in quitting smoking. The secondary aims are to evaluate the acceptability, satisfaction, and cost-effectiveness of the WQ modality.

DISCUSSION

If the WQ modality is determined to be effective, acceptable, and affordable, it will be relatively easy to reach and provide professional cessation treatments to the communities, thus helping to reduce the disparities in smoking cessation services between different regions and socioeconomic groups.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR2200066427, Registered December 5, 2022.

A qualitative study assessing how reach and participation can be improved in workplace smoking cessation programs

INTRODUCTION

Randomized controlled trials have demonstrated the effectiveness of workplace smoking cessation programs. However, with low participation rates reported, it is important to understand the barriers and facilitators for the reach and participation of employees in workplace smoking cessation programs. The objective of the present study is to uncover the needs of employees regarding reach and participation when implementing a workplace program to address smoking cessation.

METHODS

We carried out 19 semi-structured qualitative interviews in 2019 based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework with current and former smoking employees of organizations with ≥100 employees in the Netherlands. Some of the interviewees had experience with a cessation program. Data were analyzed using the Framework method.

RESULTS

The main barriers according to employees were insufficient promotion of the cessation program, completing the program in the employee’s own time and working night shifts and peak hours. Facilitators included being actively approached to participate by a colleague, positive reactions from colleagues about employee’s participation in the program, providing the program on location and integrating the program as part of the organization’s vitality policy.

CONCLUSIONS

Effective workplace programs for smoking cessation can stimulate cessation but implementers often experience low participation rates. Our study presents recommendations to improve the recruitment and participation of employees in a workplace smoking cessation program, such as using active communication strategies, training managers to stimulate smoking employees to participate and making the program as accessible as possible by reimbursing time spent and offering the program at the workplace or nearby. Integrating the smoking cessation program into wider company vitality policy will also aid continued provision of the program.

Psychosocial Life Aspects among Substance Misuse Clients who are at Rehabilitation Phase: A Narrative Review

Objective

The present study aimed at exploring the psychosocial life aspects among substance misuse clients through conducting a review of the literature related to the research topic. A scoping search in the literature revealed the significant lack of both local, regional and international studies exploring the psychosocial life aspects among substance misuse clients who are at the rehabilitation stage.

Method

A comprehensive literature search was performed using the keywords: "psychosocial, "psychological", "social", "life", "rehabilitation" and "substance misuse". The search process was performed in the following electronic databases "MEDLINE, PubMed, CINAHL, PsycINFO". Full text articles, published in English during the period between 2016 and 2021 were included in the literature.

Results

A total of 7 studies were found to be in relation with the topic addressed in this study, which is the psychosocial life aspects of substance misuse clients at rehabilitation phase. The results showed that there is a significant weakness of psychosocial life aspects among substance misuse clients, in addition to a significant lack of both educational and training program that aim at enhancing and improving the psychosocial life aspects among substance misuse clients who are at the rehabilitation phase.

Conclusion

The study concluded that there should be concise and clear measurement tools to be used in assessing the psychosocial life aspects of substance misuse clients who are the rehabilitation phase.

Usage, acceptability, and preliminary effectiveness of an mHealth-based integrated modality for smoking cessation interventions in Western China

INTRODUCTION

Many smokers have not accessed professional smoking cessation assistance due to limited smoking cessation services. We developed a novel mHealth-based integrated modality for smoking cessation (WeChat + Quitline modality, WQ modality) and applied it to a large public welfare project (China Western-QUIT Program) in western China. This study evaluated the usage, acceptability, and preliminary effectiveness of the WQ modality in the population of western China.

METHODS

A prospective cohort study was conducted between April and August 2021. Smokers or their relatives were recruited through online advertisements and medical staff referrals. After using the services of the WQ modality for one month, the self-reported awareness, use, and satisfaction with each service among the participants were collected by a telephone interview. We also evaluated the self-reported 7-day point prevalence of abstinence (PPA) and quit attempt rate among baseline current smokers. The usage data of each service were downloaded from quitline and WeChat platforms.

RESULTS

Of the 17326 people from western China using the WQ modality, the largest number of users was WeChat official account (11173), followed by WeChat mini program (3734), WeChat group (669), and quitline (541 inbound calls, 605 outbound calls). At one month follow-up, over 70% of participants who completed the baseline survey (n=2221) were aware of WeChat-based services, and over 50% used them. However, the awareness rate (11.1%) and utilization rate (0.5%) of quitline were relatively low. The median satisfaction scores across all services were 9 out of 10 points (IQR: 8-9). Among the baseline current smokers (n=1257), self-reported 7-day PPA was 41.8% (526/1257), and another 225 smokers (17.9%) reported making a quit attempt.

CONCLUSIONS

The WQ modality could be well used and accepted, and it has great potential to motivate and aid short-term smoking cessation in smokers from western China.

The Evaluation Of Smoking Cessation Treatment Success and Related Factors in Adults Age 65 Years and Older

OBJECTIVES

The aim was to evaluate smoking cessation treatment success and factors associated in older adults.

METHODS

In the retrospective cohort study, the patients' sociodemographic data, smoking history, Fagerström Test for Nicotine Dependence scores (FTND), type of treatments (Pharmacological treatments, behavioral counseling, and/or both) and the number of follow-up sessions in the Smoking Cessation Outpatient Clinic were taken from hospital files of the patients. Treatment success was evaluated as one year of abstinence from smoking.

RESULTS

Participants' reported with 53% classified as high-very high nicotine dependence. Overall, 36% reported abstinence from smoking for one year or more. Treatment success was associated with higher attendance at follow-up sessions. Using pharmacologic treatments and behavioral counseling together was proved to be more effective than behavioral counseling alone.

CONCLUSIONS

One-year smoking cessation was achieved in one-third of older adults attending a smoking cessation clinic. In older adults in this sample low FTND scores, use of combined pharmacologic and behavioral treatment, and attendance at follow up sessions were associated with one year smoking abstinence.

CLINICAL IMPLICATIONS

Older adults should be referred for smoking cessation treatment. Use of combined pharmacological and behavioral counseling is recommended. Efforts to enhance attendance at follow-up sessions should be considered.

Changes in attitudes towards smoking during smoking cessation courses for Turkish- and Albanian-speaking migrants in Switzerland and its association with smoking behavior: A latent change score approach

Introduction

Migrant populations usually report higher smoking rates than locals. At the same time, people with a migration background have little or no access to regular smoking cessation treatment. In the last two decades, regular smoking cessation courses were adapted to reach out to Turkish- and Albanian-speaking migrants living in Switzerland. The main aims of the current study were (1) to analyze the effects of an adapted smoking cessation course for Turkish- and Albanian-speaking migrants in Switzerland on attitudes toward smoking and smoking behavior; and (2) to elucidate whether changes in attitudes toward smoking were associated to changes in smoking behavior in the short- and in the long-term.

Methods

A total of 59 smoking cessation courses (Turkish: 37; Albanian: 22) with 436 participants (T: 268; A: 168) held between 2014 and 2019 were evaluated. Attitudes toward smoking and cigarettes smoked per day were assessed at baseline and 3-months follow-up. One-year follow-up calls included assessment of cigarettes smoked per day. Data were analyzed by means of structural equation modeling with latent change scores.

Results

Participation in an adapted smoking cessation course led to a decrease of positive attitudes toward smoking (T: β = -0.65, p < 0.001; A: β = -0.68, p < 0.001) and a decrease of cigarettes smoked per day in the short-term (T: β = -0.58, p < 0.001; A: β = -0.43, p < 0.001) with only Turkish-speaking migrants further reducing their smoking in the long-term (T: β = -0.59, p < 0.001; A: β = -0.14, p = 0.57). Greater decreases in positive attitudes were associated with greater reductions of smoking in the short-term (T: r = 0.39, p < 0.001; A: r = 0.32, p = 0.03), but not in the long-term (T: r = -0.01, p = 0.88; A: r = -0.001, p = 0.99).

Conclusion

The adapted smoking cessation courses fostered changes in positive attitudes toward smoking that were associated with intended behavior change in the short-term. The importance of socio-cognitive characteristics related to behavior change maintenance to further increase treatment effectiveness in the long-term is discussed.

"It Needs a Full-Time Dedicated Person to Do This Job in Our Local Communities with Our Aboriginal Health Services"-Aboriginal and Torres Strait Islander Health Workers and Practitioners Perspectives on Supporting Smoking Cessation during Pregnancy

BACKGROUND

Aboriginal and Torres Strait Islander women deserve improved smoking cessation support. Aboriginal health workers (AHW) and practitioners (AHP) can be central to the provision of culturally safe smoking cessation care (SCC). The objective of this study is to explore attitudes and the perceived role of AHWs/AHPs toward providing SCC to Aboriginal and Torres Strait Islander pregnant women.

METHOD

A mixed-method study using quantitative and qualitative data was conducted among AHW/AHPs in 2021 across Australia. Descriptive and analytical statistics were used to characterise AHWs'/AHPs' attitudes towards SCC and to evaluate the factors associated with perceptions of who is best placed to provide SCC.

RESULTS

From the total AHW/AHP workforce, 21.2% (223) completed the survey. Less than half (48.4%) believed that AHW/AHP were best placed to provide SCC for pregnant women. The majority believed that group-based supports (82.5%) and cultural support programs (63.7%) were the best strategies to support Aboriginal and Torres Strait Islander pregnant women to quit smoking.

CONCLUSION

This study highlights the need to enhance SCC offered to Aboriginal and Torres Strait Islander pregnant women. A targeted workforce dedicated to smoking cessation should be resourced, including funding, standardised training, and ongoing SCC support tailored to Aboriginal and Torres Strait Islander pregnant women.

Quality of service and commitment to tobacco dependence treatment for individuals living with mental disorders in France: A pilot study

BACKGROUND

There are remarkably high smoking rates in patients living with mental disorders (PLWMD), and the absence of a specific treatment policy for smoking cessation for these patients worldwide. The present study aimed to (i) investigate the quality of service and commitment to tobacco dependence treatment, and (ii) produce high-quality French versions of the Index of Tobacco Treatment Quality (ITTQ) and Tobacco Treatment Commitment Scale (TTCS).

METHODS

ITTQ and TTCS were used to assess French mental health professionals (n = 80). Both scales were translated from their original language following standard procedures (i.e. forward translation). Descriptive analysis for total score, each factor and item were calculated for the entire sample, followed by subgroup analysis by gender, and role of the practitioner.

RESULTS

Nurses presented higher levels of both treatment commitment and treatment quality in their mental health care units, compared to psychiatrists, and residents. Overall, counseling offering was low and there was a perception that it is unfair to take tobacco away from PLWMD. In the other hand, there were high levels of smoking assessment and perceptions that nicotine dependence should be included in drug treatment programs.

CONCLUSIONS

There is a gap in tobacco treatment implementation for French PLWMD. The present pilot study alerts about the problem, and should stimulate larger studies validating such measures for wide use with French-speaking mental health professionals. French nurses presented higher levels of both treatment commitment and quality, and could be in a leadership position for such implementation. Encouraging the implementation of tobacco counseling within conventional mental health treatment is critical to improve cessation rates among this population. There is a potential for the sustainability of tobacco treatment interventions since the levels of commitment observed here were higher than in previous studies conducted abroad.

Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review

Osteoporosis is a highly prevalent condition affecting a growing number of patients affected by chronic obstructive pulmonary disease (COPD), with crucial implications for risk of fragility fractures, hospitalization, and mortality. Several risk factors have been identified to have a role in osteoporosis development in COPD patients, including corticosteroid therapy, systemic inflammation, smoke, physical activity levels, malnutrition, and sarcopenia. In this scenario, a personalized multitarget intervention focusing on the pathological mechanisms underpinning osteoporosis is mandatory to improve bone health in these frail patients. Specifically, physical exercise, nutritional approach, dietary supplements, and smoke cessation are the cornerstone of the lifestyle approach to osteoporosis in COPD patients, improving not only bone health but also physical performance and balance. On the other hand, pharmacological treatment should be considered for both the prevention and treatment of osteoporosis in patients at higher risk of fragility fractures. Despite these considerations, several barriers still affect the integration of a personalized approach to managing osteoporosis in COPD patients. However, digital innovation solutions and telemedicine might have a role in optimizing sustainable networking between hospital assistance and community settings to improve bone health and reduce sanitary costs of the long-term management of COPD patients with osteoporosis.

Intensive versus short face-to-face smoking cessation interventions: a meta-analysis

OBJECTIVES

To evaluate the efficacy of intensive smoking cessation interventions (ISCIs) directly compared with shorter interventions (SIs), measured as successful quitting.

METHOD

Medline, Embase, the Cochrane Library and CINAHL were searched on 15 October 2021. Peer-reviewed randomised controlled trials (RCTs) of adult, daily smokers undergoing an ISCI were included. No setting, time or language restrictions were imposed. Risk of bias and quality of evidence was assessed using the Cochrane tool and Grading of Recommendations, Assessment, Development and Evaluation, respectively. Meta-analyses were conducted using a random-effects model.

RESULTS

17 550 unique articles were identified and 17 RCTs evaluating 9812 smokers were included. 14 studies were conducted in Europe or the USA. The quality of the evidence was assessed as low or moderate. Continuous abstinence was significantly higher in ISCIs in the long term (risk ratio 2.60, 95% CI 1.71-3.97). Direction and magnitude were similar in the short term; however, they were not statistically significant (risk ratio 2.49, 95% CI: 0.94-6.56). When measured as point prevalence, successful quitting was still statistically significant in favour of ISCIs, but lower (long term: 1.64, 1.08-2.47; short term: 1.68, 1.10-2.56). Sensitivity analysis confirmed the robustness of the results.

CONCLUSION

ISCIs are highly effective compared to SIs. This important knowledge should be used to avoid additional morbidity and mortality caused by smoking.

Effects of chess-based cognitive remediation training as therapy add-on in alcohol and tobacco use disorders: protocol of a randomised, controlled clinical fMRI trial

BACKGROUND

Alcohol and tobacco use disorders (AUD, TUD) are frequent, both worldwide and in the German population, and cognitive impairments are known to facilitate instances of relapse. Cognitive training has been proposed for enhancing cognitive functioning and possibly improving treatment outcome in mental disorders. However, these effects and underlying neurobiological mechanisms are not yet fully understood regarding AUD and TUD. Examining the effect of chess-based cognitive remediation training (CB-CRT) on neurobiological, neuropsychological and psychosocial aspects as well as treatment outcomes will provide insights into mechanisms underlying relapse and abstinence and might help to improve health behaviour in affected individuals if used as therapy add-on.

METHODS AND ANALYSIS

N=96 individuals with either AUD (N=48) or TUD (N=48) between 18 and 65 years of age will participate in a randomised, controlled clinical functional MRI (fMRI) trial. Two control groups will receive treatment as usual, that is, AUD treatment in a clinic, TUD outpatient treatment. Two therapy add-on groups will receive a 6-week CB-CRT as a therapy add-on. FMRI tasks, neurocognitive tests will be administered before and afterwards. All individuals will be followed up on monthly for 3 months. Endpoints include alterations in neural activation and neuropsychological task performance, psychosocial functioning, and relapse or substance intake. Regarding fMRI analyses, a general linear model will be applied, and t-tests, full factorial models and regression analyses will be conducted on the second level. Behavioural and psychometric data will be analysed using t-tests, regression analyses, repeated measures and one-way analyses of variance.

ETHICS AND DISSEMINATION

This study has been approved by the ethics committee of the medical faculty Mannheim of the University of Heidelberg (2017-647N-MA). The findings of this study will be presented at conferences and published in peer-reviewed journals.

TRIAL REGISTRATION

The study was registered in the Clinical Trials Register (trial identifier: NCT04057534 at clinicaltrials.gov).

A process evaluation of 'We Can Quit': a community-based smoking cessation intervention targeting women from areas of socio-disadvantage in Ireland

Background

Smoking poses a serious risk of early preventable death and disease especially for women living with socio-economic disadvantage (SED). A smoking cessation programme, ‘We Can Quit’, was developed in Ireland tailored to SED women. This includes group-based support delivered by trained lay local community facilitators (CFs) and free nicotine replacement therapy (NRT). The intervention was pilot tested in a cluster randomised controlled trial, ‘We Can Quit 2’. This paper reports on the WCQ2 process evaluation which assessed feasibility and acceptability of the programme and trial processes.

Methods

Embedded qualitative design using the UK Medical Research Council’s process evaluation framework. Semi-structured interviews with trial participants (N = 21) and CFs (N = 8). Thematic analysis was utilised.

Results

Peer-modelling, a non-judgemental environment, CFs facilitation of group support were viewed as acceptable programme related factors. Some participants expressed concerns about NRT side effects. Provision of free NRT was welcomed and accepted by participants, although structural barriers made access challenging. Pharmacists took on a role that became larger than originally envisaged – and the majority provided additional support to women in their quit attempts between group meetings which augmented and supplemented the intervention sessions provided by the CFs. Participants reported good acceptance of repeated measures for data collection, but mixed acceptability of provision of saliva samples. Low literacy affected the feasibility of some women to fully engage with programme and trial-related materials. This was despite efforts made by intervention developers and the trial team to make materials (e.g., participant intervention booklet; consent forms and participant information leaflets) accessible while also meeting requirements under 2018 European General Data Protection Regulation legislation. Hypothetical scenarios of direct (e.g., researcher present during programme delivery) and indirect (e.g., audio recordings of programme sessions) observational fidelity assessments for a future definitive trial (DT) were acceptable.

Conclusions

Intervention and trial-related processes were generally feasible and acceptable to participants and CFs. Any future DT will need to take further steps to mitigate structural barriers to accessing free NRT; and the established problem of low literacy and low educational attainment in SED areas, while continuing to comply within the contemporary legislative research environment.

Trial registration

WCQ2 pilot trial (ISRCTN74721694).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13957-5.

A Randomized Clinical Trial to Assess the Efficacy of a Psychological Treatment to Quit Smoking Assisted with an App: Study Protocol

Numerous studies have shown the efficacy of smoking cessation interventions. However, some challenges, such as relapse rates, remain. The availability of information technologies (ICTs) offers promising opportunities to address such challenges. The aim of this paper is to describe the protocol followed to assess the efficacy of a face-to-face cognitive-behavioral intervention for smoking cessation using a smartphone application as a complement, compared with a control group. A single blind, two-arm, randomized controlled trial is proposed (NCT04765813). The participants will be smokers over 18 years old, who smoke at least eight cigarettes per day. Participants will be randomized to one of two conditions, using a 1:1 allocation ratio: (1) cognitive-behavioral smoking cessation treatment along with an App with active therapeutic components (SinHumo App); or (2) cognitive-behavioral treatment along with the use of a control App (without active components). The experimental App will be used during the eight treatment sessions and for 12 months after the end of treatment. The primary outcome measures will be 7-days point-prevalence abstinence at 12-months follow-up. We expect the experimental App to obtain higher abstinence rates at the end of treatment and at one-year post-treatment follow-ups and lower relapse rates, compared to the control App.

FEASIBILITY OF THE MULTIMODAL SMOKING CESSATION INTERVENTION DURING HOSPITALIZATION WITH SIX-MONTH FOLLOW-UP POST-DISCHARGE: A PILOT STUDY

The main aim of this pilot project was to introduce multimodal smoking cessation intervention in the hospital setting and to analyze users' satisfaction and efficacy of the intervention within six months post-discharge. Multimodal intervention for smoking cessation was used and it consisted of the "5 A's" model (Ask, Advice, Assess, Assist, Arrange) for behavior change, printed self-help materials for smoking cessation, and telephone counseling (one, three and six months after discharge from the hospital). The main outcome of the study was smoking status at six months. A total of 103 participants were included in this pilot project. At six-month follow-up, 49% of participants self-reported continuous non-smoking. Among the remaining participants, 20 reported smoking reduction, 19 were still smoking, and 16 participants were unable to make contact with. In the logistic regression, among all analyzed variables, only two of them were positively associated with smoking cessation after six months: participants' response that they would like to quit smoking within the next six months (B=4.688; p=0.018) and answering that they did not smoke when they were ill and bed-ridden due to illness (B=3.253; p=0.020). Satisfaction with the intervention was very high; 70% of participants rated the intervention as 'excellent'. Therefore, multimodal smoking cessation intervention can be successfully introduced at hospital setting yielding high smoking abstinence rates at six months post-discharge and high level of user satisfaction. Healthcare workers who work in hospitals should be educated so they can provide such intervention on a regular basis.

Behavioural programmes for cigarette smoking cessation: investigating interactions between behavioural, motivational and delivery components in a systematic review and component network meta-analysis

AIMS

To investigate the comparative and combined effectiveness of four types of components of behavioural interventions for cigarette smoking cessation: behavioural (e.g. counselling), motivational (e.g. focus on reasons to quit), delivery mode (e.g. phone) and provider (e.g. nurse).

DESIGN

Systematic review and component network meta-analysis of randomised controlled trials identified from Cochrane reviews. Interventions included behavioural interventions for smoking cessation (including all non-pharmacological interventions, e.g. counselling, exercise, hypnotherapy, self-help materials), compared with another behavioural intervention or no support. Building on a 2021 review (CD013229), we conducted three analyses, investigating: comparative effectiveness of the components, whether models that allowed interactions between components gave different results to models assuming additivity, and predicted effect estimates for combined effects of components that had showed promise but where there were few trials.

SETTING

Community and health-care settings.

PARTICIPANTS

Adults who smoke tobacco.

MEASUREMENTS

Smoking cessation at ≥6 months, preferring sustained, biochemically validated outcomes where available.

FINDINGS

Three hundred and twelve trials (250 563 participants) were included. Fifty were at high risk of bias using Cochrane risk of bias tool, V1 (ROB1); excluding these studies did not change findings. Head-to-head comparisons of components suggested that support via text message (SMS) compared with telephone (OR 1.48, 95% CrI 1.13-1.94) or print materials (OR 1.44, 95% CrI 1.14-1.83) was more effective, and individual delivery was less effective than delivery as part of a group (OR 0.78, 95% CrI 0.64-0.95). There was no conclusive evidence of synergistic or antagonistic interactions when combining components that were commonly used together. Adding multiple components that are commonly used in behavioural counselling suggested clinically relevant and statistically conclusive evidence of benefit. Components with the largest effects that could be combined, but rarely have been, were estimated to increase the odds of quitting between two and threefold. For example, financial incentives delivered via SMS, with tailoring and a focus on how to quit, had an estimated OR of 2.94 (95% CrI 1.91-4.52).

CONCLUSIONS

Among the components of behavioural support for smoking cessation, behavioural counselling and guaranteed financial incentives are associated with the greatest success. Incorporating additional components associated with effectiveness may further increase benefit, with delivery via text message showing particular promise.

The effectiveness of smoking cessation interventions in rural and remote populations: Systematic review and meta-analyses

BACKGROUND

Rural and remote residents are more likely to smoke tobacco than those in major cities. However, they may experience unique systemic, provider, and individual barriers to accessing smoking cessation treatments, including distance and limited resources. Understanding the effectiveness of smoking cessation interventions in this population is important due to higher smoking-related disease burden and death compared to those in major cities.

METHODS

Medline, EMBASE, Scopus, PsychINFO, and Cochrane Library were searched until 19-02/2021. Inclusion criteria were randomised controlled trials (RCTs), cluster RCTs, randomised trials, or cluster randomised trials investigating behavioural interventions and pharmacotherapies for smoking cessation in rural and remote populations compared with a control or another smoking cessation treatment; and published in English. Given there is no internationally-standardised rurality index, definitions of 'rural' and 'remote' used by authors of studies were applied to reflect their country. Exclusion criteria were studies of non-combustible smoking cessation; and studies with urban participants in the sample. Two reviewers independently screened records for eligibility, extracted data from studies utilising a modified Cochrane Effective Practice and Organisation of Care Group form, and rated methodological quality using the Quality Assessment Tool for Quantitative Studies.

RESULTS

Sixteen studies were included. Meta-analysis revealed a statistically significant treatment effect of individual face-to-face counselling on smoking cessation (RR 2.35, 95% CI 1.16-4.76, I²=0%) in rural and remote populations. There was no statistically significant treatment effect for nicotine replacement therapy (RR 2.97, 95% CI 0.84-10.53, I²=47%), telephone-counselling (RR 1.69, 95% CI 0.56-5.06, I²=62%), and community-based multiple-interventions (RR:1.57, 95% CI 0.89-2.78, I²=85%). Certainty of evidence was rated very low for each meta-analysis.

CONCLUSION

Despite limited resources in rural and remote settings, individual face-to-face counselling for smoking cessation appears promising. Given the limited number of studies, further research about the effectiveness of smoking cessation interventions in rural and remote populations is warranted.

Residential treatment exclusively for smoking cessation in patients with Crohn’s disease: Results from a pilot study

INTRODUCTION

Cigarette smoking is a risk factor for the induction and severity of the course of Crohn’s disease (CD). Hospital admission may be required for treatment of the disease but is generally not available solely for smoking cessation. Outpatient group therapy is readily available, however long-term quit rates are limited. Residential treatment for smoking cessation may offer a more intense contact between patient and therapist, and may result in higher abstinence rates in a sensitive group of patients. The objective of this pilot study is to evaluate the feasibility of implementing a residential program with hospital admission, exclusively for smoking cessation for patients suffering from CD.

METHODS

Twelve eligible smokers suffering from CD were recruited for a 9-day inpatient smoking cessation treatment. Treatment consisted of single and group behavioral therapy together with supportive measures such as exercise therapy, relaxation techniques or nutritional counselling. Nicotine replacement therapy or prescription medication was offered according to the Fagerström test for nicotine dependence (FTND) score and treatment guidelines. Quit rates were assessed by CO-testing during hospital treatment and by follow-up calls 6 months after discharge.

RESULTS

All recruited participants arrived on time for treatment and collectively stopped smoking on the 2nd day after admission. All participants completed the therapy process without relapse and left the hospital smoke-free (100% quit rate on discharge, CO monitored). Self-reported abstinence rates after 6 months were 72.7% for continuous abstinence and 81.8% for 7-day point prevalence abstinence.

CONCLUSIONS

Residential treatment exclusively for smoking cessation is feasible and efficient and may be a valuable treatment option for patients suffering from CD.

The effect of aerobic exercises of different intensities on anxiety, cigarette addiction, sleep quality, and quality of life in former smokers

BACKGROUND

There is a worldwide struggle to quit smoking and prevent relapsing. Aerobic exercises are frequently utilized to aid in smoking cessation and prevent relapse.

AIMS

This study aimed to investigate the effects of aerobic exercises of different intensity on the level of anxiety, smoking addiction, and quality of sleep and life in former smokers.

METHODS

The study included 60 people aged 18 to 45 who had quit smoking within the previous month. Individuals were randomly assigned to control (CON), mild-intensity aerobic activity (MIA), and moderate-intensity aerobic activity (MoIA) groups. The MIA group did submaximal aerobic exercises at 40% of maximum heart rate (MHR), while the MoIA group did them at 60% of MHR for 8 weeks/3 days. Participants' anxiety levels were assessed using the Beck Anxiety Scale (BAS), smoking addiction was assessed using the Fagerström Test for Nicotine Dependence and Substance Craving Scale (SCS), sleep quality was assessed using the Pittsburgh Sleep Quality Index, and quality of life was assessed using the SF-36 Short Form Scale (SF-36).

RESULTS

The SCS score of the MoIA group declined more than the MIA and CON groups, and the MIA group had a lower sleep disturbance score than other groups when the influence of exercise training was assessed over time (p < 0.05). Aerobic exercise had no influence on SF-36 or BAS scores (p > 0.05).

CONCLUSIONS

The benefits of mild and moderate aerobic exercise on quality of life and anxiety are similar. However, mild-intensity aerobic exercises may be suitable for sleep difficulties while moderate-intensity aerobic exercises may be preferred for reducing smoking addiction.

Examining Attitudes, Expectations, and Tobacco Cessation Treatment Outcomes Among Incarcerated Tobacco Smokers

People who are incarcerated have limited resources to help them quit tobacco smoking. This study assessed the association between baseline attitudes and expectations of the program with final smoking status as the outcome. A 6-week group-based counseling with nicotine patches was provided to incarcerated individuals to quit smoking. A cross-sectional survey was given at the first session. Questions surrounding attitudes such as interest, confidence, motivation, and expectations were used to assess associations with smoking cessation. Exhaled carbon monoxide (CO) levels were taken at each sessions. Participants were categorized as nonsmoking or continued smoking at a 6.0 parts per million (ppm) CO at their final session attended. Overall, 123 participants had a CO higher than 6.0 ppm or missed more than two sessions at their final session, and 54 had a CO under 6.0 ppm. A total of 102 participants completed the 6-week program. Differences among the two groups in exhaled CO began at Session 3 and continued throughout the study.

Stationäre Behandlung exklusiv zur Raucherentwöhnung – Konzept einer intensivierten verhaltenstherapeutischen Gruppentherapie

Zielsetzung Angesichts hoher Morbidität und Mortalität durch Tabakabhängigkeit besteht ein dringender Bedarf an effektiven Angeboten zur Raucherentwöhnung. Die leitliniengemäß durchgeführten ambulanten Therapien sind in ihrer langfristigen Wirksamkeit jedoch limitiert. Im Folgenden wird ein erstmalig in Deutschland entwickeltes wissenschaftliches stationäres Therapiekonzept ausschließlich zur stationären Raucherentwöhnung beschrieben und die Evidenz für die langfristige Effektivität dieser intensivierten Therapieform zur Raucherentwöhnung diskutiert.

Methodik Es handelt es sich um ein multimodales neuntägiges verhaltenstherapeutisches Therapiekonzept für den stationären Einsatz. Die Entwöhnung wird als Gruppentherapie leitliniengemäß von einem mobil einsetzbaren Team geschulter Raucherentwöhner:innen durchgeführt, ergänzt durch Angebote zur Förderung der Gruppenkohäsion, Tagesstrukturierung, zum Bewegungstraining, Ernährungsmanagement, Ressourcenaufbau, Expositionstraining rückfallkritischer Situationen und zur achtsamkeitsbasierten Stressbewältigung.

Schlussfolgerungen Eine stationäre Raucherentwöhnungstherapie ist als vielversprechende Ergänzung bzw. Alternative zur ambulanten Entwöhnung umsetzbar. Die intrinsische Abstinenzmotivation soll in einem geschützten Rahmen bei professioneller Betreuung und Unterstützung in der Gruppe gestärkt werden mit Fokus auf den Transfer der Kompetenzen in den Alltag. Erste Studienergebnisse weisen auf eine hohe langfristige Entwöhnungsquote hin. Eine wissenschaftliche Überprüfung der (Kosten-)Effektivität anhand randomisiert-kontrollierter Studien steht noch aus.

Embedding comprehensive smoking cessation programs into community clinics: study protocol for a cluster-randomized controlled trial

BACKGROUND

Cigarette smoking among adults in the USA is a leading cause of preventable death worldwide, even though there has been a decline in prevalence since 2005. The addictive nature of nicotine is the chief reason smokers continue to use tobacco. Although the majority of smokers report a desire to quit smoking, a small minority who attempt to quit achieve long-term cessation. Combined, smoking cessation best practices include coordinated medication and behavioral treatments. However, these treatments are not currently adequately delivered to Medi-Cal beneficiaries in the publicly funded patient-centered medical homes (PCMHs) and community mental health clinics operated by Los Angeles County (LAC)-Department of Health Services (LACDHS) and LAC-Department of Mental Health (LACDMH).

METHODS

This is a 5-year implementation, cluster-randomized comparative effectiveness trial that will support the implementation of smoking cessation services delivered in LAC-LACDHS-operated outpatient primary care clinics and in LAC-LACDMH-operated community mental health clinics. We will enroll 1000 participants from clinics that will offer smoking cessation services and 200 from clinics that will offer treatment as usual. Participants will be asked to complete assessments at baseline, 3 months, 6 months, and 12 months. The assessments will include self-reports on smoking history, anxiety, stress, quality of life, and participant satisfaction. Participants who are assigned to clinics that provide smoking cessation services will also be asked about the frequency of their participation in the smoking cessation services during the 12-month period.

DISCUSSION

This study will evaluate the effectiveness and feasibility of implementing smoking cessation services in outpatient primary care and community mental health clinics. It will also determine if there will be higher rates of smoking cessation in the implementation sites as compared to the sites with treatment as usual. If the implementation proves to be effective, the plan is to sustain these services using a workflow we will develop in the LAC-operated sites. This would lead to ameliorating the significant smoking cessation treatment gaps among those served within the LAC Health Agency departments.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04717544 "Embedding comprehensive smoking cessation programs into community clinics." Registered on January 22, 2021.

Smoking Cessation

Tobacco smoking is the leading cause of preventable death in the United States, and its harms are well established. Physicians have more evidence-based resources than ever before to effectively treat smoking, including new uses and combinations of U.S. Food and Drug Administration-approved pharmacotherapies and expanded community programs. In addition, electronic nicotine delivery systems are potential treatment tools, but their safety and efficacy need to be established. Finally, high-priority groups, such as persons with cancer diagnoses or hospitalized patients, may benefit from particular attention to their tobacco use.

Effectiveness of psychosocial interventions among older adults with mild cognitive impairment: a systematic review and meta-analysis

OBJECTIVES

This review aimed to examine available evidence concerning the effectiveness of psychosocial interventions in improving memory, executive function, depression and activities of daily living (ADL) in older adults with MCI.

METHODS

Eight electronic databases were used to conduct a comprehensive literature search for published and unpublished studies. A primary outcome was cognitive function, including memory and executive function. Secondary outcomes were depression and ADL. Two researchers independently appraised quality of included studies and extracted data. Meta-analysis, heterogeneity test, subgroup analysis and sensitivity analyses were performed.

RESULTS

Ten studies (out of 1,265 records) were included in this review. Psychosocial interventions contributed to a significant improvement in memory, not executive function, depression and ADL. Subgroup analyses suggested that interventions with a longer duration, more therapeutic sessions, and individual format had larger effect sizes. Strategies found to enhance memory entailed behavior modification and activation, memory training, visual imagery, storytelling, memory aids, journaling, and exercise.

CONCLUSION

Healthcare providers may offer psychosocial interventions to client with MCI in clinical settings. Higher quality trials should be conducted to increase solid evidence in this domain.

The Usability of an Online Tool to Promote the Use of Evidence-Based Smoking Cessation Interventions

To increase usage of evidence-based smoking cessation interventions (EBSCIs) among smokers, an online decision aid (DA) was developed. The aims of this study were (1) to conduct a usability evaluation; (2) to conduct a program evaluation and evaluate decisional conflict after using the DA and (3) to determine the possible change in the intention to use EBSCIs before and directly after reviewing the DA. A cross-sectional study was carried out in September 2020 by recruiting smokers via the Internet (n = 497). Chi-squared tests and t-tests were conducted to test the differences between smokers who differed in the perceived usability of the DA on the program evaluation and in decisional conflict. The possible changes in intention to use EBSCIs during a cessation attempt before and after reviewing the DA were tested using t-tests, McNemar's test and χ2 analysis. The participants evaluated the usability of the DA as moderate (MU; n = 393, 79.1%) or good (GU; n = 104, 20.9%). GU smokers rated higher on all the elements of the program evaluation and experienced less decisional conflict, but also displayed a higher intention to quit. After reviewing the DA, the participants on average had a significantly higher intention to use more EBSCIs, in particular in the form of eHealth. Recommendations to make the DA more usable could include tailoring, using video-based information and including value clarification methods. Furthermore, a hybrid variant in which smokers can use the DA independently and with the guidance of a primary care professional could aid both groups in choosing a fitting EBSCI option.