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Abushamma S, Chen LS, Chen J, Smock N, Pham G, Chen CH. Enabling tobacco treatment for gastroenterology patients via a novel low-burden point-of-care model. BMC Health Serv Res 2024; 24:752. [PMID: 38902682 PMCID: PMC11188289 DOI: 10.1186/s12913-024-11092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/08/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND & AIM Smoking is a major risk factor for multiple gastrointestinal cancers, and adversely affects peptic ulcer disease, gastroesophageal reflux, pancreatitis and Crohn's disease. Despite key recommendations for diagnosing and treating tobacco use disorder in healthcare settings, the degree to which this is implemented in Gastroenterology (GI) clinics is unknown. We aimed to assess our providers' practices, identify barriers for implementing evidence-based smoking cessation treatments, and address these barriers by implementing a novel low-burden point of care Electronic health record-enabled evidence-based tobacco treatment (ELEVATE), in GI clinics. METHODS An online survey was distributed to clinic gastroenterologists. ELEVATE module training was implemented in 1/2021. Data were evaluated during pre (7/2020-12/2020) and post (1/2021-12/2021) implementation periods to evaluate the reach and effectiveness of ELEVATE. Generalized estimating equations (GEE) were used to generate rate ratios (RR) to evaluate the intervention. RESULTS 91% (20/22) of GI physicians responded to our survey, and only 20% often assisted patients who smoke with counseling. Lack of a systematic program to offer help to patients was reported by 80% of providers as an extremely/very important barrier limiting their smoking cessation practices. The proportion of current patients who smoke receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (14.36-27.47%, RR = 1.90, 95% CI 1.60-2.26, p < .001). Post-ELEVATE, 14.4% (38/264) of patients with treatment quit smoking, compared to 7.9% (55/697) of patients without treatment (RR = 1.89, 95% CI 1.26-2.82, p = .0021). CONCLUSION Smoking practices are frequently assessed in GI clinics but barriers limiting cessation treatment exist. The use of a low burden point of care EHR enabled smoking cessation treatment module has led to a significant improvement in the treatment of smoking and subsequent cessation in our clinics. This study sheds light on an often under-recognized source of morbidity in GI patients and identifies an efficient, effective, and scalable strategy to combat tobacco use and improve clinical outcomes in our patients.
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Affiliation(s)
- Suha Abushamma
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, 600 S. Euclid Avenue, MSC-8124-21-427, Saint Louis, MO, 63110, USA.
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jingling Chen
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Giang Pham
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Chien-Huan Chen
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University School of Medicine, 600 S. Euclid Avenue, MSC-8124-21-427, Saint Louis, MO, 63110, USA
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Kraiss J, Viechtbauer W, Black N, Johnston M, Hartmann‐Boyce J, Eisma M, Javornik N, Bricca A, Michie S, West R, de Bruin M. Estimating the true effectiveness of smoking cessation interventions under variable comparator conditions: A systematic review and meta-regression. Addiction 2023; 118:1835-1850. [PMID: 37132077 PMCID: PMC10952237 DOI: 10.1111/add.16222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/07/2023] [Indexed: 05/04/2023]
Abstract
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.
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Affiliation(s)
- Jannis Kraiss
- Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Department of Psychology, Health, and TechnologyUniversity of TwenteEnschedeThe Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtThe Netherlands
| | - Nicola Black
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| | - Marie Johnston
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| | | | - Maarten Eisma
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Neza Javornik
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| | - Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and PhysiotherapyUniversity of Southern DenmarkOdenseDenmark
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrezNæstved‐Slagelse‐Ringsted HospitalsSlagelseDenmark
| | - Susan Michie
- Centre for Behaviour ChangeUniversity College LondonLondonUK
| | - Robert West
- Department of Epidemiology and Public Health, Health Behaviour Research CentreUniversity College LondonLondonUK
| | - Marijn de Bruin
- Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
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Al-Dahshan A, Al Muraikhi H, Musa S, Joudeh A, Al Baker W, Selim N, Bougmiza I. Prevalence and predictors of smoking cessation among smokers receiving smoking cessation intervention in primary care in Qatar: a 6-month follow-up study. Front Public Health 2023; 11:1166016. [PMID: 37275499 PMCID: PMC10235512 DOI: 10.3389/fpubh.2023.1166016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Objective To estimate the rate and predictors of smoking cessation in smokers attending smoking cessation clinics in primary care settings in Qatar. Methods A cross-sectional study was conducted among 759 smokers who had attended any of the 10 smoking cessation clinics in primary health care centers from January 2019 to June 2020. The sociodemographic, clinical, and smoking-related variables were assessed. Tailored behavioral and pharmacotherapy were delivered, and patients were interviewed at 6 months to estimate the 30-day point prevalence abstinence. To identify independent factors associated with smoking cessation, a multivariable logistic regression analysis was performed. Results The mean age of participants was 40.6 (±11.3), majority being married, Arab and employed, and having a tertiary education. Almost half of the smokers (48.7%) received varenicline alone, 42.6% received NRT, and 31.8% received a combination of both. The selection of drug therapy was based on preferences, experiences, and history of previously encountered adverse effects. The overall 30-day quit rate at 6 months follow-up was 32.4%. About three-quarters (72.5%) of participants had at least one quit attempt and 12.5% had 3 or more attempts. Later age at smoking initiation, lower cigarette consumption at baseline, lower CO concentration at baseline, use of smoking cessation pharmacotherapy, having made fewer quit attempts and non-exposure to secondhand smoke among friends were identified as significant predictors of successful quitting at 6 months. Conclusion The 30-day quit rate at 6 months follow-up (32.4%) is comparable to the worldwide figure. However, further efforts should be made to plan cost-effective tobacco dependence treatment taking into account predictors and at-risk groups.
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Affiliation(s)
- Ayman Al-Dahshan
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Hissa Al Muraikhi
- Department of Preventative Health, Primary Health Care Corporation, Doha, Qatar
| | - Sarah Musa
- Department of Preventative Health, Primary Health Care Corporation, Doha, Qatar
| | - Anwar Joudeh
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Wadha Al Baker
- Department of Preventative Health, Primary Health Care Corporation, Doha, Qatar
| | - Nagah Selim
- Department of Community Medicine, Primary Health Care Corporation, Doha, Qatar
- Department of Public Health and Preventive Medicine, Cairo University, Giza, Egypt
| | - Iheb Bougmiza
- Department of Community Medicine, Primary Health Care Corporation, Doha, Qatar
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Alvarado Echeona LC, Cortes Cardona JP, Toledo JD, Rodríguez Real S, Ramírez Peñuela B. [Identifying non-pharmacological strategies for reduction and cessation of tobacco use in university studentsIdentificação de estratégias não farmacológicas para reduzir e suspender o consumo de tabaco por estudantes universitários]. Rev Panam Salud Publica 2023; 47:e9. [PMID: 36788964 PMCID: PMC9910555 DOI: 10.26633/rpsp.2023.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/05/2022] [Indexed: 02/11/2023] Open
Abstract
Objective Identify non-pharmacological strategies for reduction and cessation of tobacco use, aimed at the community of undergraduate university students. Methods Classic systematic review of experimental scientific literature published in the last 20 years in databases and grey literature. The search algorithm consisted of using the maximum amount of terminology that described the research question, resulting in the largest number of results in the different databases. Evidence tables were constructed with the FLC 3.0 assessment tool and Excel 2021. Use of the GRADE tool enabled assessment of the quality of scientific evidence. Risk of bias was estimated in accordance with recommendations in the Cochrane Handbook of Systematic Reviews of Interventions. A narrative summary of the included studies was provided, given the high degree of heterogeneity established by I2 statistics. Results A search of databases and grey literature obtained 40 823 articles. After the application of inclusion and exclusion criteria, seven articles were included: one study with impact on cessation, two studies on reduction, and four studies with an impact on both the reduction and cessation of tobacco use. The methodological quality was "good" according to the GRADE tool. The overall risk of bias was 'low'. The high clinical and methodological heterogeneity of the studies prevented grouping for the construction of a meta-analysis. Conclusion Data from the seven articles show that non-pharmacological interventions can result in reduction and cessation of tobacco use in the university student population, although the evidence is still limited. Further studies are necessary in order to develop strong recommendations for implementation.
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Affiliation(s)
| | - Juan Pablo Cortes Cardona
- Universidad El BosqueBogotáColombiaUniversidad El Bosque, Bogotá, Colombia.,Juan Pablo Cortes Cardona,
| | - José Daniel Toledo
- Grupo de Investigación de Epidemiología y Salud ColectivaFundación Universitaria de Ciencias de la SaludUniversidad Militar Nueva GranadaBogotáColombiaGrupo de Investigación de Epidemiología y Salud Colectiva, Fundación Universitaria de Ciencias de la Salud, Universidad Militar Nueva Granada, Bogotá, Colombia.
| | - Sheyla Rodríguez Real
- Grupo de Investigación de Epidemiología y Salud ColectivaFundación Universitaria de Ciencias de la SaludUniversidad Militar Nueva GranadaBogotáColombiaGrupo de Investigación de Epidemiología y Salud Colectiva, Fundación Universitaria de Ciencias de la Salud, Universidad Militar Nueva Granada, Bogotá, Colombia.
| | - Bibiana Ramírez Peñuela
- Grupo de Investigación de Epidemiología y Salud ColectivaFundación Universitaria de Ciencias de la SaludUniversidad Militar Nueva GranadaBogotáColombiaGrupo de Investigación de Epidemiología y Salud Colectiva, Fundación Universitaria de Ciencias de la Salud, Universidad Militar Nueva Granada, Bogotá, Colombia.
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Saroj SK, Bhardwaj T. Non-pharmacological interventions for tobacco cessation: A systematic review of existing practices and their effectiveness. Monaldi Arch Chest Dis 2022; 92. [PMID: 35347975 DOI: 10.4081/monaldi.2022.2229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Smoking tobacco is associated with lung cancer and other life-threatening diseases which requires serious action to curb it. Tobacco cessation interventions are available as pharmacological and non-pharmacological methods or a combination of both. The present review examines the effectiveness of the existing non-pharmacological tobacco cessation interventions and synthesizes the result for the future development of drug-free treatment in the community for tobacco cessation. The literature search was conducted in August 2020, using two electronic databases (PubMed and JSTOR), with search terms: ['tobacco cessation' OR 'smoking cessation'] AND ['intervention'] which included studies published during 2010 and 2020 (till 31st July 2020). All studies were limited to English language, human participants and excluded patients with comorbidities. A total of 2,114 publications were retrieved out of which 11 articles were reviewed. On the basis of intervention used in reviewed studies, we categorized them into seven categories: i. incentive-based intervention, ii. exercise based, iii. telephone-based proactive counselling, iv. mobile phone SMS (Short Message Service) based, v. smartphone app (application) based, vi. web-based intervention, vii. self-help material. Incentives were provided in most of the studies to maintain the retention rate and motivate the participants for completing follow-up. Non-pharmacological interventions for tobacco cessation include a combination of various elements. Our findings suggest that behavioural counselling is one of the most important elements of any non-pharmacological intervention. In addition to behaviour counselling, yoga and exercises along with self-help material, video and phone counselling may have higher efficacy. Thus, practicing non-pharmacological interventions may also increase the cessation rate and reduce the tobacco use burden.
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Affiliation(s)
| | - Tushti Bhardwaj
- Social Work Department, Dr. B. R. Ambedkar College, University of Delhi, New Delhi.
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Chockalingam L, Ha TV, Bui Q, Hershow RB, Hoffman I, Go VF. Barriers and facilitators to smoking cessation among HIV-infected people who inject drugs (PWID) in Hanoi, Vietnam: a qualitative study. Cancer Causes Control 2021; 32:391-399. [PMID: 33559769 DOI: 10.1007/s10552-021-01396-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In Vietnam, 60% of men living with HIV smoke tobacco, and 92% of HIV-infected people who inject drugs (PWID) smoke tobacco. Tobacco use increases mortality through increased health risks including tuberculosis and malignancy in HIV-infected smokers. However, tobacco use treatment is not widely available in Vietnam. The objective was to examine current barriers and facilitators of smoking cessation and tobacco use treatment for HIV-infected PWID in Hanoi, Vietnam. METHODS Native speaking ethnographers conducted semi-structured qualitative interviews about tobacco use and tobacco use treatment with sixteen HIV-infected PWID and eight healthcare providers, recruited from four HIV-Methadone Maintenance Treatment (MMT) clinics in Hanoi, Vietnam. Interviews were recorded, transcribed, and translated for thematic analysis in Dedoose. RESULTS Clients and providers had learned the general health risks of smoking from public awareness campaigns. Half had tried to quit previously, often motivated by advice from family members but not by HIV providers' advice. Almost all clients did not want to quit, citing the low price of tobacco, prevalence of smoking in Vietnam, and physical cravings. HIV provider's counseling was brief, inconsistent, and limited by low provider knowledge and competing burdens of HIV and injection drug use. Providers recently trained by NGO-led seminars on tobacco prioritized tobacco use treatment. CONCLUSIONS Smoking cessation efforts for people living with HIV/AIDS (PLHA) and PWID smokers in Hanoi, Vietnam could benefit from further community public awareness campaigns, and exploring increased tobacco taxation. Tobacco use treatment at HIV clinics could benefit from involving family and friends in cessation, and training providers in treatment methods.
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Affiliation(s)
- L Chockalingam
- University of Colorado School of Medicine, Aurora, CO, 80045, USA.
| | - T V Ha
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA.,UNC Project-Vietnam, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Hanoi, Vietnam
| | - Q Bui
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA
| | - R B Hershow
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA
| | - I Hoffman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - V F Go
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA
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Murray RL, Brain K, Britton J, Quinn-Scoggins HD, Lewis S, McCutchan GM, Quaife SL, Wu Q, Ashurst A, Baldwin D, Crosbie PAJ, Neal RD, Parrott S, Rogerson S, Thorley R, Callister ME. Yorkshire Enhanced Stop Smoking (YESS) study: a protocol for a randomised controlled trial to evaluate the effect of adding a personalised smoking cessation intervention to a lung cancer screening programme. BMJ Open 2020; 10:e037086. [PMID: 32912948 PMCID: PMC7485260 DOI: 10.1136/bmjopen-2020-037086] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Integration of smoking cessation (SC) into lung cancer screening is essential to optimise clinical and cost effectiveness. The most effective way to use this 'teachable moment' is unclear. The Yorkshire Enhanced Stop Smoking study will measure the effectiveness of an SC service integrated within the Yorkshire Lung Screening Trial (YLST) and will test the efficacy of a personalised SC intervention, incorporating incidental findings detected on the low-dose CT scan performed as part of YLST. METHODS AND ANALYSIS Unless explicitly declined, all smokers enrolled in YLST will see an SC practitioner at baseline and receive SC support over 4 weeks comprising behavioural support, pharmacotherapy and/or a commercially available e-cigarette. Eligible smokers will be randomised (1:1 in permuted blocks of random size up to size 6) to receive either an enhanced, personalised SC support package, including CT scan images, or continued standard best practice. Anticipated recruitment is 1040 smokers (January 2019-December 2020). The primary objective is to measure 7-day point prevalent carbon monoxide (CO) validated SC after 3 months. Secondary outcomes include CO validated cessation at 4 weeks and 12 months, self-reported continuous cessation at 4 weeks, 3 months and 12 months, attempts to quit smoking and changes in psychological variables, including perceived risk of lung cancer, motivation to quit smoking tobacco, confidence and efficacy beliefs (self and response) at all follow-up points. A process evaluation will explore under which circumstances and on which groups the intervention works best, test intervention fidelity and theory test the mechanisms of intervention impact. ETHICS AND DISSEMINATION This study has been approved by the East Midlands-Derby Research Ethics Committee (18/EM/0199) and the Health Research Authority/Health and Care Research Wales. Results will be disseminated through publication in peer-reviewed scientific journals, presentation at conferences and via the YLST website. TRIAL REGISTRATION NUMBERS ISRCTN63825779, NCT03750110.
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Affiliation(s)
- Rachael L Murray
- Division of Epidemiology & Public Health, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - John Britton
- Division of Epidemiology & Public Health, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | | | - Sarah Lewis
- Division of Epidemiology & Public Health, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Grace M McCutchan
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Qi Wu
- Department of Health Sciences, University of York, York, UK
| | - Alex Ashurst
- Department of Radiology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - David Baldwin
- Deaprtment of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Wythenshawe, UK
| | - Richard D Neal
- Institute of Health Science, University of Leeds, Leeds, United Kingdom
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Suzanne Rogerson
- Research and Innivation CSU, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Rebecca Thorley
- Division of Epidemiology & Public Health, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Matthew Ej Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, United Kingdom
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Black N, Eisma MC, Viechtbauer W, Johnston M, West R, Hartmann‐Boyce J, Michie S, de Bruin M. Variability and effectiveness of comparator group interventions in smoking cessation trials: a systematic review and meta-analysis. Addiction 2020; 115:1607-1617. [PMID: 32043675 PMCID: PMC7496125 DOI: 10.1111/add.14969] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/08/2019] [Accepted: 01/10/2020] [Indexed: 12/22/2022]
Abstract
AIMS To examine variability and effectiveness of interventions provided to comparator (control) groups in smoking cessation trials. METHODS Systematic review with meta-analysis of randomized controlled trials (RCTs) of behavioral interventions for smoking cessation, with or without stop-smoking medication. We searched the Cochrane Tobacco Addiction Group Specialized Register for RCTs with objective outcomes measured at ≥ 6 months. Study authors were contacted to obtain comprehensive descriptions of their comparator interventions. Meta-regression analyses examined the relationships of smoking cessation rates with stop-smoking medication and behavior change techniques. RESULTS One hundred and four of 142 eligible comparator groups (n = 23 706) had complete data and were included in analyses. There was considerable variability in the number of behavior change techniques delivered [mean = 15.97, standard deviation (SD) = 13.54, range = 0-45] and the provision of smoking cessation medication (43% of groups received medication) throughout and within categories of comparator groups (e.g. usual care, brief advice). Higher smoking cessation rates were predicted by provision of medication [B = 0.334, 95% confidence interval (CI) = 0.030-0.638, P = 0.031] and number of behavior change techniques included (B = 0.020, 95% CI = 0.008-0.032, P < 0.001). Modelled cessation rates in comparator groups that received the most intensive support were 15 percentage points higher than those that received the least (23 versus 8%). CONCLUSIONS Interventions delivered to comparator groups in smoking cessation randomized controlled trials vary considerably in content, and cessation rates are strongly predicted by stop-smoking medication and number of behavior change techniques delivered.
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Affiliation(s)
- Nicola Black
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Health Sciences Building, ForesterhillAberdeenUK
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
| | - Maarten C. Eisma
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Health Sciences Building, ForesterhillAberdeenUK
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenthe Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | - Marie Johnston
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Health Sciences Building, ForesterhillAberdeenUK
| | - Robert West
- Department of Behavioral Science and HealthUniversity College LondonLondonUK
| | | | - Susan Michie
- Centre for behavior ChangeUniversity College LondonGower StreetLondonWC1E 6BTUK
| | - Marijn de Bruin
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Health Sciences Building, ForesterhillAberdeenUK
- Radboud University Medical CenterRadboud Institute for Health Sciences, IQ HealthcareNijmegenthe Netherlands
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Odorico M, Le Goff D, Aerts N, Bastiaens H, Le Reste JY. How To Support Smoking Cessation In Primary Care And The Community: A Systematic Review Of Interventions For The Prevention Of Cardiovascular Diseases. Vasc Health Risk Manag 2019; 15:485-502. [PMID: 31802882 PMCID: PMC6827500 DOI: 10.2147/vhrm.s221744] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/14/2019] [Indexed: 01/18/2023] Open
Abstract
Introduction Smoking is a major risk factor for cardiovascular diseases (CVDs) and for many types of cancers. Despite recent policies, 1.1 billion people are active smokers and tobacco is the leading cause of mortality and illness throughout the world. The aim of this work was to identify smoking cessation interventions which could be implemented in primary care and/or at a community level. Methods A systematic review of CVDs prevention guidelines was realized using the ADAPTE Process. These were identified on G-I-N and TRIP databases. Additionally, a purposive search for national guidelines was successfully undertaken. Guidelines focusing on non-pharmacological lifestyle interventions, published or updated after 2011, were included. Exclusion criteria were specific populations, management of acute disease and exclusive focus on pharmacological or surgical interventions. After appraisal with the AGREE II tool, high-quality guidelines were included for analysis. High-grade recommendations and the supporting bibliographic references were extracted. References had to be checked in detail where sufficient information was not available in the guidelines. Results Nine hundred and ten guidelines were identified, 47 evaluated with AGREE II and 26 included. Guidelines recommended that patients quit smoking and that health care professionals provided advice to smokers but failed to propose precise implementation strategies for such recommendations. Only two guidelines provided specific recommendations. In the guideline bibliographic references, brief advice (BA) and multiple session strategies were identified as effective interventions. These interventions used Prochaska theory, motivational interviewing or cognitive-behavioral therapies. Self-help documentation alone was less effective than face-to-face counseling. Community-based or workplace public interventions alone did not seem effective. Discussion Behavioral change strategies were effective in helping patients to give up smoking. BA alone was less effective than multiple session strategies although it required fewer resources. Evidence for community-based interventions effectiveness was weak, mainly due to the lack of robust studies.
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Affiliation(s)
- Michele Odorico
- Department of General Practice, EA 7479 SPURBO, Université de Bretagne Occidentale (UBO - University of West Brittany), Brest, France
| | - Delphine Le Goff
- Department of General Practice, EA 7479 SPURBO, Université de Bretagne Occidentale (UBO - University of West Brittany), Brest, France
| | - Naomi Aerts
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Jean Yves Le Reste
- Department of General Practice, EA 7479 SPURBO, Université de Bretagne Occidentale (UBO - University of West Brittany), Brest, France
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Imtiaz MH, Ramos-Garcia RI, Wattal S, Tiffany S, Sazonov E. Wearable Sensors for Monitoring of Cigarette Smoking in Free-Living: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2019; 19:E4678. [PMID: 31661856 PMCID: PMC6864810 DOI: 10.3390/s19214678] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 01/28/2023]
Abstract
Globally, cigarette smoking is widespread among all ages, and smokers struggle to quit. The design of effective cessation interventions requires an accurate and objective assessment of smoking frequency and smoke exposure metrics. Recently, wearable devices have emerged as a means of assessing cigarette use. However, wearable technologies have inherent limitations, and their sensor responses are often influenced by wearers' behavior, motion and environmental factors. This paper presents a systematic review of current and forthcoming wearable technologies, with a focus on sensing elements, body placement, detection accuracy, underlying algorithms and applications. Full-texts of 86 scientific articles were reviewed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines to address three research questions oriented to cigarette smoking, in order to: (1) Investigate the behavioral and physiological manifestations of cigarette smoking targeted by wearable sensors for smoking detection; (2) explore sensor modalities employed for detecting these manifestations; (3) evaluate underlying signal processing and pattern recognition methodologies and key performance metrics. The review identified five specific smoking manifestations targeted by sensors. The results suggested that no system reached 100% accuracy in the detection or evaluation of smoking-related features. Also, the testing of these sensors was mostly limited to laboratory settings. For a realistic evaluation of accuracy metrics, wearable devices require thorough testing under free-living conditions.
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Affiliation(s)
- Masudul H Imtiaz
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Raul I Ramos-Garcia
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Shashank Wattal
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Stephen Tiffany
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 12246, USA.
| | - Edward Sazonov
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA.
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Jackson SE, Kotz D, West R, Brown J. Moderators of real-world effectiveness of smoking cessation aids: a population study. Addiction 2019; 114:1627-1638. [PMID: 31117151 PMCID: PMC6684357 DOI: 10.1111/add.14656] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/01/2019] [Accepted: 05/03/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Understanding whether and how far smokers' characteristics influence the effectiveness of treatment may be important for tailoring recommendations on cessation aids to those most likely to help the user achieve abstinence. This study aimed to estimate the effectiveness of commonly used smoking cessation aids and test whether their effectiveness differs according to cigarette addiction, socio-economic status, age or sex. DESIGN Correlational design using cross-sectional survey data collected monthly between 2006 and 2018. SETTING England. PARTICIPANTS A total of 18 929 adults (aged ≥ 16 years, 52.0% female) who had smoked within the previous 12 months and had made at least one quit attempt during that period. MEASUREMENTS The outcome was self-reported abstinence from quit date to survey. Independent variables were self-reported use during the most recent quit attempt of: prescription nicotine replacement therapy (NRT), NRT over-the-counter, varenicline, bupropion, e-cigarettes, face-to-face behavioural support, telephone support, written self-help materials, websites and hypnotherapy. Moderators were cigarette addiction, social grade, age and sex. FINDINGS After adjustment for covariates and use of other cessation aids, users of e-cigarettes [odds ratio (OR) = 1.95, 95% confidence interval (CI) = 1.69-2.24] and varenicline (OR = 1.82, 95% CI = 1.51-2.21) had significantly higher odds of reporting abstinence than those who did not report use of these cessation aids. Use of prescription NRT was associated with increased abstinence in older (≥ 45 years) (OR = 1.58, 95% CI = 1.25-2.00) but not younger (< 45 years) smokers (OR = 1.09, 95% CI = 0.85-1.42). Use of websites was associated with increased abstinence in smokers from lower (OR = 2.20, 95% CI = 1.22-3.98) but not higher social grades (OR = 0.74, 95% CI = 0.40-1.38). There was little evidence of benefits of using other cessation aids. CONCLUSIONS Use of e-cigarettes and varenicline are associated with higher abstinence rates following a quit attempt in England. Use of prescription of nicotine replacement therapy is also associated with higher abstinence rates, but only in older smokers, and use of websites only in smokers from lower socio-economic status.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Daniel Kotz
- Department of Behavioural Science and Health, University College London, London, UK
- Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Institute of General Practice, Düsseldorf, Germany
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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12
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Supporting cancer patients quit smoking: the initial evaluation of our tobacco cessation intervention program. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396919000451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Tobacco is a known addictive consumer product and its use has been reported to be associated with several health problems as well as the leading cause of premature, preventable mortality worldwide. For patients undergoing cancer treatment, tobacco smoking can potentially compromise treatment effectiveness; however, there is sufficient evidence suggesting numerous health benefits of smoking cessation interventions for cancer patients.Methods:The Grand River Regional Cancer Centre (GRRCC) smoking cessation program began in October 2013 to provide evidence-based intensive tobacco intervention to patients. All new patients are screened for tobacco use and those identified as active smokers are advised of the benefits of cessation and offered referral to the program where a cessation nurse offers counseling. Patients’ disease site, initial cessation goal, quit date, number of quit attempts and mode of contact are collected by the cessation nurse. This study reports on the initial evaluation of the smoking cessation program activities at GRRCC.Results:There are 1,210 patients who were screened, accepted a referral and counseled in the program. The referral pattern shows a modest increase every year and most of the patients (58%) indicated readiness to quit smoking. Overall, 29 and 26% of patients either quit or cut-back smoking, respectively. Among 348 patients who quit smoking, 300 (86%) were able to quit at the first attempt. The data indicated that 309 (44%) out of the 698 patients who indicated their initial intent to quit smoking were able to quit, whereas about 242 (35%) were able to cutback. A total of 15 patients out of 32 who indicated initial readiness to ‘cutback’ smoking were able to reduce tobacco use and three patients actually ended up quitting, although their initial goal was ‘ready-to-cut-back’.Conclusions:GRRCC smoking cessation program started in October 2013 to provide evidence-based intensive smoking cessation interventions for patients with cancer. Most patients referred to the program indicated a readiness to quit smoking affirming that if patients become aware of the various risks associated with continual smoking or if they are informed of the benefits associated with cessation with regard to their treatment, they will be more likely to decide to quit. Therefore, it is essential that patients, their partners and families are counseled on the health and treatment benefits of smoking cessation and sustainable programs should be available to support them to quit smoking. It is imperative then, that oncology programs should consistently identify and document the smoking status of cancer patients and support those who use tobacco at the time of diagnosis to quit. Evidence-based smoking cessation intervention should be sustainably integrated into the cancer care continuum in all oncology programs from prevention of cancer through diagnosis, treatment, survivorship and palliative care.
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Zeng L, Yu X, Yu T, Xiao J, Huang Y. Interventions for smoking cessation in people diagnosed with lung cancer. Cochrane Database Syst Rev 2019; 6:CD011751. [PMID: 31173336 PMCID: PMC6554694 DOI: 10.1002/14651858.cd011751.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lung cancer is one of the most common causes of death from cancer worldwide. Smoking induces and aggravates many health problems, including vascular diseases, respiratory illnesses and cancers. Tobacco smoking constitutes the most important risk factor for lung cancer. Most people with lung cancer are still active smokers at diagnosis or frequently relapse after smoking cessation. Quitting smoking is the most effective way for smokers to reduce the risk of premature death and disability. People with lung cancer may benefit from stopping smoking. Whether smoking cessation interventions are effective for people with lung cancer and whether one method of quitting is more effective than any other has not been systematically reviewed. OBJECTIVES To determine the effectiveness of smoking cessation programmes for people with lung cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (accessed via PubMed) and Embase up to 22 December 2018. We also searched the American Society of Clinical Oncology (ASCO) Annual Meeting proceedings, the lung cancer sections of the proceedings of the ESMO Congress, the lung cancer sections of the proceedings of the European Conference of Clinical Oncology (ECCO) Congress, the World Conference on Lung Cancer proceedings, the Society for Research on Nicotine and Tobacco Annual Meeting from 2013, the Food and Drug Administration website, the European Medicine Agency for drug registration website, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, ClinicalTrials.gov, and the metaRegister of Controlled Trials (mRCT) to 30 December 2018. We applied no restriction on language of publication. SELECTION CRITERIA We planned to include any randomised controlled trial (RCT) of any psychosocial or pharmacological smoking cessation intervention or combinations of both, compared with no intervention, a different psychosocial or pharmacological (or both) intervention or placebo for pharmacological interventions in people with lung cancer. DATA COLLECTION AND ANALYSIS Two review authors independently screened the studies from the initial search for potential trials for inclusion. We planned to use standard methodological procedures expected by Cochrane. We found no trials that met the inclusion criteria. MAIN RESULTS We identified no RCTs that met our inclusion criteria. Among the 1817 records retrieved using our search strategy, we retrieved 19 studies for further investigation. We excluded 15 trials: ten trials because we could not distinguish people with lung cancer from the other participants, or the participants were not people with lung cancer, four because they were not randomised, or RCTs. We excluded one trial because, though it was completed in 2004, no results are available. We assessed four ongoing trials for inclusion when data become available. AUTHORS' CONCLUSIONS There were no RCTs that determined the effectiveness of any type of smoking cessation programme for people with lung cancer. There was insufficient evidence to determine whether smoking cessation interventions are effective for people with lung cancer and whether one programme is more effective than any other. People with lung cancer should be encouraged to quit smoking and offered smoking cessation interventions. However, due to the lack of RCTs, the efficacy of smoking cessation interventions for people with lung cancer cannot be evaluated and concluded. This systematic review identified a need for RCTs to explore these.
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Affiliation(s)
- Linmiao Zeng
- Mindong Hospital Affiliated to Fujian Medical UniversityDepartment of Respiratory MedicineNo. 89, He'shan RoadFu'an CityFujian ProvinceChina355000
| | - Xiaolian Yu
- Fujian Mindong Medical SchoolNo. 65 Mancun RoadFu'an CityFujianChina355017
| | - Tingting Yu
- Fujian Vocational College of BioengineeringDepartment of ManagementNo.42 Hongshan bridgeCangshan DistrictFuzhouChina350002
| | - Jianhong Xiao
- Mindong Hospital Affiliated to Fujian Medical UniversityDepartment of Respiratory MedicineNo. 89, He'shan RoadFu'an CityFujian ProvinceChina355000
| | - Yushan Huang
- Medical College of Jinggangshan UniversityNo 28, Xueyuan RoadJi An CityJianXi ProvinceChina343000
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Landau MJ, Cameron LD, Arndt J, Hamilton WK, Swanson TJ, Bultmann M. Beneath the surface: Abstract construal mindset increases receptivity to metaphors in health communications. SOCIAL COGNITION 2019; 37:314-340. [PMID: 33828353 PMCID: PMC8023340 DOI: 10.1521/soco.2019.37.3.314] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Widespread messages use metaphoric language and imagery to prompt recipients to interpret health-related concepts in terms of dissimilar, familiar concepts (e.g., "fight the war on cancer"). When do these messages work? According to Conceptual Metaphor Theory, thinking metaphorically involves looking past concepts' superficial differences to identify their similarities at a structural level. Thus, we hypothesized that when people's general construal mindset is oriented to focus on information's abstract meaning, not its concrete details, they would process a metaphor's target health concept in ways that correspond to the dissimilar concept. Accordingly, after priming an abstract, but not concrete, construal mindset: framing sun exposure as enemy confrontation (vs. literally) increased cancer risk perceptions and sun-safe intentions (Study 1; N=186); and framing smoking cessation as an arduous journey (vs. literally) increased appreciation of quitting difficulties and interest in cessation tools (Study 2; N=244). We discuss practical and theoretical implications for improving health communication.
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Affiliation(s)
| | - Linda D Cameron
- Department of Psychological Sciences, University of California-Merced
| | - Jamie Arndt
- Department of Psychological Sciences, University of Missouri-Columbia
| | - W Kyle Hamilton
- Department of Psychological Sciences, University of California-Merced
| | | | - Michael Bultmann
- Department of Psychological Sciences, University of Missouri-Columbia
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Stockings E, Black N, Bartlem KM, Metse AP, Regan T, Bailey JM, Wolfenden L, Wiggers J, Bowman JA. Outpatient interventions for smoking cessation and reduction for adults with a mental disorder. Hippokratia 2019. [DOI: 10.1002/14651858.cd013286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Emily Stockings
- University of New South Wales; National Drug and Alcohol Research Centre (NDARC); Sydney Australia
| | - Nicola Black
- University of New South Wales; National Drug and Alcohol Research Centre (NDARC); Sydney Australia
| | - Kate M Bartlem
- University of Newcastle; School of Psychology; University Drive Callaghan New South Wales Australia 2308
| | - Alexandra P Metse
- University of Newcastle; School of Psychology; University Drive Callaghan New South Wales Australia 2308
| | - Tim Regan
- Hunter New England Local Health District; Hunter New England Population Health; Locked Bag 10 Wallsend NSW Australia 2287
| | - Jacqueline M Bailey
- University of Newcastle; School of Psychology; University Drive Callaghan New South Wales Australia 2308
| | - Luke Wolfenden
- University of Newcastle; School of Medicine and Public Health; Callaghan NSW Australia 2308
| | - John Wiggers
- Hunter New England Local Health District; Hunter New England Population Health; Locked Bag 10 Wallsend NSW Australia 2287
| | - Jennifer A Bowman
- University of Newcastle; School of Psychology; University Drive Callaghan New South Wales Australia 2308
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16
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Li L, Lee JH, Sutton SK, Simmons VN, Brandon TH. A Bayesian transition model for missing longitudinal binary outcomes and an application to a smoking cessation study. STAT MODEL 2019; 20:310-338. [PMID: 33854408 DOI: 10.1177/1471082x18821489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Smoking cessation intervention studies often produce data on smoking status at discrete follow-up assessments, often with missing data in different amounts at each assessment. Smoking status in these studies is a dynamic process with individuals transitioning from smoking to abstinent, as well as abstinent to smoking, at different times during the intervention. Directly assessing transitions provides an opportunity to answer important questions like 'Does the proposed intervention help smokers remain abstinent or quit smoking more effectively than other interventions?' In this article, we model changes in smoking status and examine how interventions and other covariates affect the transitions. We propose a Bayesian approach for fitting the transition model to the observed data and impute missing outcomes based on a logistic model, which accounts for both missing at random (MAR) and missing not at random (MNAR) mechanisms. The proposed Bayesian approach treats missing data as additional unknown quantities and samples them from their posterior distributions. The performance of the proposed method is investigated through simulation studies and illustrated by data from a randomized controlled trial of smoking cessation interventions. Finally, posterior predictive checking and log pseudo marginal likelihood (LPML) are used to assess model assumptions and perform model comparisons, respectively.
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Affiliation(s)
- Li Li
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM, USA
| | - Ji-Hyun Lee
- Division of Quantitative Sciences, University of Florida Health Cancer Center; Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Vani N Simmons
- Department of Health Outcomes and Behaviour, Moffitt Cancer Center, Tampa, FL, USA
| | - Thomas H Brandon
- Department of Health Outcomes and Behaviour, Moffitt Cancer Center, Tampa, FL, USA
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Hersi M, Traversy G, Thombs BD, Beck A, Skidmore B, Groulx S, Lang E, Reynolds DL, Wilson B, Bernstein SL, Selby P, Johnson-Obaseki S, Manuel D, Pakhale S, Presseau J, Courage S, Hutton B, Shea BJ, Welch V, Morrow M, Little J, Stevens A. Effectiveness of stop smoking interventions among adults: protocol for an overview of systematic reviews and an updated systematic review. Syst Rev 2019; 8:28. [PMID: 30660199 PMCID: PMC6339342 DOI: 10.1186/s13643-018-0928-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/20/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tobacco smoking is the leading cause of cancer, preventable death, and disability. Smoking cessation can increase life expectancy by nearly a decade if achieved in the third or fourth decades of life. Various stop smoking interventions are available including pharmacotherapies, electronic cigarettes, behavioural support, and alternative therapies. This protocol outlines an evidence review which will evaluate the benefits and harms of stop smoking interventions in adults. METHODS The evidence review will consist of two stages. First, an overview of systematic reviews evaluating the benefits and harms of various stop smoking interventions delivered in or referred from the primary care setting will be conducted. The second stage will involve updating a systematic review on electronic cigarettes identified in the overview; randomized controlled trials will be considered for outcomes relating to benefits while randomized controlled trials, non-randomized controlled trials, and comparative observational studies will be considered for evaluating harms. Search strategies will be developed and peer-reviewed by medical information specialists. The search strategy for the updated review on e-cigarettes will be developed using that of the candidate systematic review. The MEDLINE®, PsycINFO, Embase, and the Cochrane Library electronic databases will be searched as of 2008 for the overview of reviews and from the last search date of the selected review for the updated review. Organizational websites and trial registries will be searched for unpublished or ongoing reviews/studies. Two reviewers will independently screen the title and abstracts of citations using the liberal accelerated method. Full-text screening will be performed independently by two reviewers. Extracted data will be verified by a second reviewer. Disagreements regarding full-text screening and data extraction will be resolved by consensus or third-party adjudication. The methodological quality of systematic reviews, risk of bias of randomized and non-randomized trials, and methodological quality of cohort studies will be evaluated using AMSTAR 2, the Cochrane risk of bias tool, and a modified version of the Scottish Intercollegiate Guidelines Network critical appraisal tool, respectively. The GRADE framework will be used to assess the quality of the evidence for outcomes. DISCUSSION The evidence review will evaluate the benefits and harms of various stop smoking interventions for adults. Findings will be used to inform a national tobacco cessation guideline by the Canadian Task Force on Preventive Health Care. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42018099691, CRD42018099692).
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Affiliation(s)
- Mona Hersi
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6 Canada
| | | | - Brett D. Thombs
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec Canada
- Department of Psychiatry, McGill University, Montreal, Quebec Canada
| | - Andrew Beck
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6 Canada
| | - Becky Skidmore
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6 Canada
| | - Stéphane Groulx
- Department of Community Health Sciences, University of Sherbrooke, Sherbrooke, Quebec Canada
- Centre de recherche Charles-Le Moyne – Saguenay–Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke, Quebec, Quebec Canada
| | - Eddy Lang
- University of Calgary Cumming School of Medicine, Calgary, Alberta Canada
- Alberta Health Services, Calgary, Alberta Canada
| | - Donna L. Reynolds
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Brenda Wilson
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John’s, Newfoundland Canada
| | - Steven L. Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT USA
| | - Peter Selby
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology, University of Ottawa, Ottawa, Ontario Canada
- The Ottawa Hospital, Ottawa, Ontario Canada
| | - Douglas Manuel
- The Ottawa Hospital, Ottawa, Ontario Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
- Bruyere Research Institute, Ottawa, Ontario Canada
| | - Smita Pakhale
- The Ottawa Hospital, Ottawa, Ontario Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario Canada
| | - Susan Courage
- Public Health Agency of Canada, Ottawa, Ontario Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6 Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Beverley J. Shea
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6 Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Vivian Welch
- Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
- Bruyere Research Institute, Ottawa, Ontario Canada
| | - Matt Morrow
- Patient representative, Vancouver, British Columbia Canada
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Adrienne Stevens
- Knowledge Synthesis Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8L6 Canada
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Livingstone‐Banks J, Ordóñez‐Mena JM, Hartmann‐Boyce J. Print-based self-help interventions for smoking cessation. Cochrane Database Syst Rev 2019; 1:CD001118. [PMID: 30623970 PMCID: PMC7112723 DOI: 10.1002/14651858.cd001118.pub4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many smokers give up smoking on their own, but materials that provide a structured programme for smokers to follow may increase the number who quit successfully. OBJECTIVES The aims of this review were to determine the effectiveness of different forms of print-based self-help materials that provide a structured programme for smokers to follow, compared with no treatment and with other minimal contact strategies, and to determine the comparative effectiveness of different components and characteristics of print-based self-help, such as computer-generated feedback, additional materials, tailoring of materials to individuals, and targeting of materials at specific groups. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Trials Register, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The date of the most recent search was March 2018. SELECTION CRITERIA We included randomised trials of smoking cessation with follow-up of at least six months, where at least one arm tested print-based materials providing self-help compared with minimal print-based self-help (such as a short leaflet) or a lower-intensity control. We defined 'self-help' as structured programming for smokers trying to quit without intensive contact with a therapist. DATA COLLECTION AND ANALYSIS We extracted data in accordance with standard methodological procedures set out by Cochrane. The main outcome measure was abstinence from smoking after at least six months' follow-up in people smoking at baseline. We used the most rigorous definition of abstinence in each study and biochemically validated rates when available. Where appropriate, we performed meta-analysis using a random-effects model. MAIN RESULTS We identified 75 studies that met our inclusion criteria. Many study reports did not include sufficient detail to allow judgement of risk of bias for some domains. We judged 30 studies (40%) to be at high risk of bias for one or more domains.Thirty-five studies evaluated the effects of standard, non-tailored self-help materials. Eleven studies compared self-help materials alone with no intervention and found a small effect in favour of the intervention (n = 13,241; risk ratio (RR) 1.19, 95% confidence interval (CI) 1.03 to 1.37; I² = 0%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for indirect relevance to populations in low- and middle-income countries because evidence for this comparison came from studies conducted solely in high-income countries and there is reason to believe the intervention might work differently in low- and middle-income countries. This analysis excluded two studies by the same author team with strongly positive outcomes that were clear outliers and introduced significant heterogeneity. Six further studies of structured self-help compared with brief leaflets did not show evidence of an effect of self-help materials on smoking cessation (n = 7023; RR 0.87, 95% CI 0.71 to 1.07; I² = 21%). We found evidence of benefit from standard self-help materials when there was brief contact that did not include smoking cessation advice (4 studies; n = 2822; RR 1.39, 95% CI 1.03 to 1.88; I² = 0%), but not when self-help was provided as an adjunct to face-to-face smoking cessation advice for all participants (11 studies; n = 5365; RR 0.99, 95% CI 0.76 to 1.28; I² = 32%).Thirty-two studies tested materials tailored for the characteristics of individual smokers, with controls receiving no materials, or stage-matched or non-tailored materials. Most of these studies used more than one mailing. Pooling studies that compared tailored self-help with no self-help, either on its own or compared with advice, or as an adjunct to advice, showed a benefit of providing tailored self-help interventions (12 studies; n = 19,190; RR 1.34, 95% CI 1.20 to 1.49; I² = 0%) with little evidence of difference between subgroups (10 studies compared tailored with no materials, n = 14,359; RR 1.34, 95% CI 1.19 to 1.51; I² = 0%; two studies compared tailored materials with brief advice, n = 2992; RR 1.13, 95% CI 0.86 to 1.49; I² = 0%; and two studies evaluated tailored materials as an adjunct to brief advice, n = 1839; RR 1.72, 95% CI 1.17 to 2.53; I² = 10%). When studies compared tailored self-help with non-tailored self-help, results favoured tailored interventions when the tailored interventions involved more mailings than the non-tailored interventions (9 studies; n = 14,166; RR 1.42, 95% CI 1.20 to 1.68; I² = 0%), but not when the two conditions were contact-matched (10 studies; n = 11,024; RR 1.07, 95% CI 0.89 to 1.30; I² = 50%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for risk of bias.Five studies evaluated self-help materials as an adjunct to nicotine replacement therapy; pooling three of these provided no evidence of additional benefit (n = 1769; RR 1.05, 95% CI 0.86 to 1.30; I² = 0%). Four studies evaluating additional written materials favoured the intervention, but the lower confidence interval crossed the line of no effect (RR 1.20, 95% CI 0.91 to 1.58; I² = 73%). A small number of other studies did not detect benefit from using targeted materials, or find differences between different self-help programmes. AUTHORS' CONCLUSIONS Moderate-certainty evidence shows that when no other support is available, written self-help materials help more people to stop smoking than no intervention. When people receive advice from a health professional or are using nicotine replacement therapy, there is no evidence that self-help materials add to their effect. However, small benefits cannot be excluded. Moderate-certainty evidence shows that self-help materials that use data from participants to tailor the nature of the advice or support given are more effective than no intervention. However, when tailored self-help materials, which typically involve repeated assessment and mailing, were compared with untailored materials delivered similarly, there was no evidence of benefit.Available evidence tested self-help interventions in high-income countries, where more intensive support is often available. Further research is needed to investigate effects of these interventions in low- and middle-income countries, where more intensive support may not be available.
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Hartmann-Boyce J, Fanshawe TR, Lindson N, Livingstone-Banks J, Ordóñez-Mena JM, Aveyard P. Behavioural interventions for smoking cessation: an overview and network meta-analysis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2018. [DOI: 10.1002/14651858.cd013229] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jamie Hartmann-Boyce
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - Thomas R Fanshawe
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - Nicola Lindson
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - Jonathan Livingstone-Banks
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - José M. Ordóñez-Mena
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - Paul Aveyard
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
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Simmons VN, Sutton SK, Meltzer LR, Unrod M, Meade CD, Brandon TH. Long-term outcomes from a self-help smoking cessation randomized controlled trial. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:710-714. [PMID: 30284878 DOI: 10.1037/adb0000401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is a need for effective smoking cessation interventions that can be disseminated easily in health care and other settings. We previously reported that an extended self-help intervention comprising intensive repeated mailings over 18 months improved abstinence rates through 6 months beyond the end of the intervention when compared to both a reduced version of the self-help materials and a traditional self-help booklet. This report extends the follow-up for an additional 6 months (30-months postbaseline) to examine long-term maintenance of the intervention effect. We hypothesized that the previously observed "dose-response" effect of treatment intensity would be maintained. Participants were randomized to Traditional Self-Help (TSH, n = 638), Standard Repeated Mailings (SRM, n = 614), or Intensive Repeated Mailings (IRM, n = 622). TSH received an existing self-help smoking cessation booklet. SRM received 8 cessation booklets mailed over 12 months. IRM received monthly mailings of 10 booklets and additional material to enhance social support over 18 months. Follow-up assessments occurred every 6 months through 30 months. Data were collected 2010-2013 and analyzed 2014-2017. At 1 year posttreatment, there was a linear dose effect with the highest abstinence rates observed in IRM (33%), followed by SRM (29%), and then TSH (23%; p = .002). Paired comparisons indicated that IRM was superior to TSH (p = .002). Results revealed a robust intervention effect for the intensive self-help intervention that was maintained 12 months after treatment completion. This further supports extended self-help as a low-cost intervention for smoking cessation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Trapero‐Bertran M, Leidl R, Muñoz C, Kulchaitanaroaj P, Coyle K, Präger M, Józwiak‐Hagymásy J, Cheung KL, Hiligsmann M, Pokhrel S. Estimates of costs for modelling return on investment from smoking cessation interventions. Addiction 2018; 113 Suppl 1:32-41. [PMID: 29532538 PMCID: PMC6033022 DOI: 10.1111/add.14091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/20/2017] [Accepted: 11/02/2017] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND AIMS Modelling return on investment (ROI) from smoking cessation interventions requires estimates of their costs and benefits. This paper describes a standardized method developed to source both economic costs of tobacco smoking and costs of implementing cessation interventions for a Europe-wide ROI model [European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD)]. DESIGN Focused search of administrative and published data. A standardized checklist was developed in order to ensure consistency in methods of data collection. SETTING AND PARTICIPANTS Adult population (15+ years) in Hungary, Netherlands, Germany, Spain and England. For passive smoking-related costs, child population (0-15 years) was also included. MEASUREMENTS Costs of treating smoking-attributable diseases; productivity losses due to smoking-attributable absenteeism; and costs of implementing smoking cessation interventions. FINDINGS Annual costs (per case) of treating smoking attributable lung cancer were between €5074 (Hungary) and €52 106 (Germany); coronary heart disease between €1521 (Spain) and €3955 (Netherlands); chronic obstructive pulmonary disease between €1280 (England) and €4199 (Spain); stroke between €1829 (Hungary) and €14 880 (Netherlands). Costs (per recipient) of smoking cessation medications were estimated to be: for standard duration of varenicline between €225 (England) and €465 (Hungary); for bupropion between €25 (Hungary) and €220 (Germany). Costs (per recipient) of providing behavioural support were also wide-ranging: one-to-one behavioural support between €34 (Hungary) and €474 (Netherlands); and group-based behavioural support between €12 (Hungary) and €257 (Germany). The costs (per recipient) of delivering brief physician advice were: €24 (England); €9 (Germany); €4 (Hungary); €33 (Netherlands); and €27 (Spain). CONCLUSIONS Costs of treating smoking-attributable diseases as well as the costs of implementing smoking cessation interventions vary substantially across Hungary, Netherlands, Germany, Spain and England. Estimates for the costs of these diseases and interventions can contribute to return on investment estimates in support of national or regional policy decisions.
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Affiliation(s)
- Marta Trapero‐Bertran
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
- Faculty of Economics and Social SciencesUniversitat Internacional de Catalunya (UIC)BarcelonaSpain
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)NeuherbergGermany
- Munich Center of Health SciencesLudwig‐Maximilians‐UniversityMunichGermany
| | - Celia Muñoz
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
| | - Puttarin Kulchaitanaroaj
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
| | - Kathryn Coyle
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
- Department of Epidemiology and Community Medicine, Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Maximilian Präger
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)NeuherbergGermany
| | - Judit Józwiak‐Hagymásy
- Faculty of Social Sciences, Department of Health Policy and Health EconomicsEötvös Loránd University, and Syreon Research InstituteBudapestHungary
| | - Kei Long Cheung
- CAPHRI Care and Public Health Research Institute, Department of Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Mickael Hiligsmann
- CAPHRI Care and Public Health Research Institute, Department of Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Subhash Pokhrel
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
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West R, Coyle K, Owen L, Coyle D, Pokhrel S. Estimates of effectiveness and reach for 'return on investment' modelling of smoking cessation interventions using data from England. Addiction 2018; 113 Suppl 1:19-31. [PMID: 28833834 PMCID: PMC6032933 DOI: 10.1111/add.14006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/10/2017] [Accepted: 08/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Estimating 'return on investment' (ROI) from smoking cessation interventions requires reach and effectiveness parameters for interventions for use in economic models such as the EQUIPT ROI tool (http://roi.equipt.eu). This paper describes the derivation of these parameter estimates for England that can be adapted to create ROI models for use by other countries. METHODS Estimates were derived for interventions in terms of their reach and effectiveness in: (1) promoting quit attempts and (2) improving the success of quit attempts (abstinence for at least 12 months). The sources were systematic reviews of efficacy supplemented by individual effectiveness evaluations and national surveys. FINDINGS Quit attempt rates were estimated to be increased by the following percentages (with reach in parentheses): 20% by tax increases raising the cost of smoking 5% above the cost of living index (100%); 10% by enforced comprehensive indoor public smoking bans (100%); 3% by mass media campaigns achieving 400 gross rating points (100%); 40% by brief opportunistic physician advice (21%); and 110% by use of a licensed nicotine product to reduce cigarette consumption (12%). Quit success rates were estimated to be increased by the following ratios: 60% by single-form nicotine replacement therapy (NRT) (5%); 114% by NRT patch plus a faster-acting NRT (2%);124% by prescribed varenicline (5%); 60% by bupropion (1%); 100% by nortriptyline (0%), 10) 298% by cytisine (0%); 40% by individual face-to-face behavioural support (2%); 37% by telephone support (0.5%); 88% by group behavioural support (1%); 63% by text messaging (0.5%); and 19% by printed self-help materials (1%). There was insufficient evidence to obtain reliable, country-specific estimates for interventions such as websites, smartphone applications and e-cigarettes. CONCLUSIONS Tax increases, indoor smoking bans, brief opportunistic physician advice and use of nicotine replacement therapy (NRT) for smoking reduction can all increase population quit attempt rates. Quit success rates can be increased by provision of NRT, varenicline, bupropion, nortriptyline, cytisine and behavioural support delivered through a variety of modalities. Parameter estimates for the effectiveness and reach of these interventions can contribute to return on investment estimates in support of national or regional policy decisions.
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Affiliation(s)
- Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Kathryn Coyle
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
| | - Lesley Owen
- Centre for GuidelinesNational Institute for Health and Care ExcellenceLondonUK
| | - Doug Coyle
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
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Trapero‐Bertran M, Muñoz C, Coyle K, Coyle D, Lester‐George A, Leidl R, Németh B, Cheung K, Pokhrel S, Lopez‐Nicolás Á. Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD. Addiction 2018; 113 Suppl 1:65-75. [PMID: 29532966 PMCID: PMC6032934 DOI: 10.1111/add.14090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/07/2017] [Accepted: 11/02/2017] [Indexed: 12/02/2022]
Abstract
AIMS To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). DESIGN We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life-time costs and benefits. SETTING Spain. PARTICIPANTS Adult smoking population (16+ years). MEASUREMENTS Health-care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality-adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates. FINDINGS The cost of implementing the current provision of smoking cessation services is approximately €61 million in the current year. This translates to 18 quitters per 1000 smokers and a life-time benefit-cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost-saving: less expensive to run and generated more QALYs) from the life-time perspective, compared with the current provision. The life-time benefit-cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline-standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis. CONCLUSIONS According to the EQUIPTMOD modelling tool it would be cost-effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro-active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run.
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Affiliation(s)
- Marta Trapero‐Bertran
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
- Faculty of Economics and Social SciencesUniversitat Internacional de Catalunya (UIC)BarcelonaSpain
| | - Celia Muñoz
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
| | - Kathryn Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonUxbridgeUK
| | - Doug Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonUxbridgeUK
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOttawaCanada
| | | | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)NeuherbergGermany
- Munich Center of Health SciencesLudwig‐Maximilians‐UniversityMunichGermany
| | - Bertalan Németh
- Faculty of Social Sciences, Department of Health Policy and Health EconomicsEötvös Loránd University, and Syreon Research InstituteBudapestHungary
| | - Kei‐Long Cheung
- Caphri School of Public Health and Primary Care, Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Subhash Pokhrel
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonUxbridgeUK
| | - Ángel Lopez‐Nicolás
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
- Department of Economics, Faculty of Business ScienceUniversidad Politécnica de Cartagena
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Németh B, Józwiak‐Hagymásy J, Kovács G, Kovács A, Demjén T, Huber MB, Cheung K, Coyle K, Lester‐George A, Pokhrel S, Vokó Z. Cost-effectiveness of possible future smoking cessation strategies in Hungary: results from the EQUIPTMOD. Addiction 2018; 113 Suppl 1:76-86. [PMID: 29368363 PMCID: PMC6032939 DOI: 10.1111/add.14089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/07/2017] [Accepted: 11/02/2017] [Indexed: 12/02/2022]
Abstract
AIMS To evaluate potential health and economic returns from implementing smoking cessation interventions in Hungary. METHODS The EQUIPTMOD, a Markov-based economic model, was used to assess the cost-effectiveness of three implementation scenarios: (a) introducing a social marketing campaign; (b) doubling the reach of existing group-based behavioural support therapies and proactive telephone support; and (c) a combination of the two scenarios. All three scenarios were compared with current practice. The scenarios were chosen as feasible options available for Hungary based on the outcome of interviews with local stakeholders. Life-time costs and quality-adjusted life years (QALYs) were calculated from a health-care perspective. The analyses used various return on investment (ROI) estimates, including incremental cost-effectiveness ratios (ICERs), to compare the scenarios. Probabilistic sensitivity analyses assessed the extent to which the estimated mean ICERs were sensitive to the model input values. RESULTS Introducing a social marketing campaign resulted in an increase of 0.3014 additional quitters per 1 000 smokers, translating to health-care cost-savings of €0.6495 per smoker compared with current practice. When the value of QALY gains was considered, cost-savings increased to €14.1598 per smoker. Doubling the reach of existing group-based behavioural support therapies and proactive telephone support resulted in health-care savings of €0.2539 per smoker (€3.9620 with the value of QALY gains), compared with current practice. The respective figures for the combined scenario were €0.8960 and €18.0062. Results were sensitive to model input values. CONCLUSIONS According to the EQUIPTMOD modelling tool, it would be cost-effective for the Hungarian authorities introduce a social marketing campaign and double the reach of existing group-based behavioural support therapies and proactive telephone support. Such policies would more than pay for themselves in the long term.
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Affiliation(s)
| | | | - Gábor Kovács
- Korányi National Institute of Tuberculosis and PulmonologyBudapestHungary
- Smoking Cessation Support CenterBudapestHungary
| | - Attila Kovács
- National Public Health and Medical Officer ServiceBudapestHungary
| | - Tibor Demjén
- National Institute for Health Development—Focal Point for Tobacco ControlBudapestHungary
| | - Manuel B. Huber
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)NeuherbergGermany
| | - Kei‐Long Cheung
- CAPHRI School of Public Health and Primary Care, Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Kathryn Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
| | | | - Subhash Pokhrel
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
| | - Zoltán Vokó
- Syreon Research InstituteBudapestHungary
- Department of Health Policy and Health EconomicsEötvös Loránd UniversityBudapestHungary
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Cheung K, Wijnen BFM, Hiligsmann M, Coyle K, Coyle D, Pokhrel S, de Vries H, Präger M, Evers SMAA. Is it cost-effective to provide internet-based interventions to complement the current provision of smoking cessation services in the Netherlands? An analysis based on the EQUIPTMOD. Addiction 2018; 113 Suppl 1:87-95. [PMID: 29243351 PMCID: PMC6032907 DOI: 10.1111/add.14069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/07/2017] [Accepted: 10/03/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM The cost-effectiveness of internet-based smoking cessation interventions is difficult to determine when they are provided as a complement to current smoking cessation services. The aim of this study was to evaluate the cost-effectiveness of such an alternate package compared with existing smoking cessation services alone (current package). METHODS A literature search was conducted to identify internet-based smoking cessation interventions in the Netherlands. A meta-analysis was then performed to determine the pooled effectiveness of a (web-based) computer-tailored intervention. The mean cost of implementing internet based interventions was calculated using available information, while intervention reach was sourced from an English study. We used EQUIPTMOD, a Markov-based state-transition model, to calculate the incremental cost-effectiveness ratios [expressed as cost per quality-adjusted life years (QALYs) gained] for different time horizons to assess the value of providing internet-based interventions to complement the current package.). Deterministic sensitivity analyses tested the uncertainty around intervention costs per smoker, relative risks, and the intervention reach. RESULTS Internet-based interventions had an estimated pooled relative risk of 1.40; average costs per smoker of €2.71; and a reach of 0.41% of all smokers. The alternate package (i.e. provision of internet-based intervention to the current package) was dominant (cost-saving) compared with the current package alone (0.14 QALY gained per 1000 smokers; reduced health-care costs of €602.91 per 1000 smokers for the life-time horizon). The alternate package remained dominant in all sensitivity analyses. CONCLUSION Providing internet-based smoking cessation interventions to complement the current provision of smoking cessation services could be a cost-saving policy option in the Netherlands.
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Affiliation(s)
- Kei‐Long Cheung
- Department of Health Services ResearchCAPHRI, Maastricht UniversityMaastrichtthe Netherlands
| | - Ben F. M. Wijnen
- Department of Health Services ResearchCAPHRI, Maastricht UniversityMaastrichtthe Netherlands
- Department of Research and DevelopmentEpilepsy Center KempenhaegheHeezethe Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services ResearchCAPHRI, Maastricht UniversityMaastrichtthe Netherlands
| | - Kathryn Coyle
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | - Doug Coyle
- School of Epidemiology, Public Health and Preventive MedicineUniversity of OttawaOttawaCanada
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | - Hein de Vries
- Department of Health PromotionCAPHRI, Maastricht UniversityMaastrichtthe Netherlands
| | - Maximilian Präger
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M)Member of the German Center for Lung Research (DZL)NeuherbergGermany
| | - Silvia M. A. A. Evers
- Department of Health Services ResearchCAPHRI, Maastricht UniversityMaastrichtthe Netherlands
- Trimbos Institute, National Institute of Mental Health and AddictionUtrechtthe Netherlands
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Bricker JB, Mull KE, McClure JB, Watson NL, Heffner JL. Improving quit rates of web-delivered interventions for smoking cessation: full-scale randomized trial of WebQuit.org versus Smokefree.gov. Addiction 2018; 113:914-923. [PMID: 29235186 PMCID: PMC5930021 DOI: 10.1111/add.14127] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/28/2017] [Accepted: 12/01/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Millions of people world-wide use websites to help them quit smoking, but effectiveness trials have an average 34% follow-up data retention rate and an average 9% quit rate. We compared the quit rates of a website using a new behavioral approach called Acceptance and Commitment Therapy (ACT; WebQuit.org) with the current standard of the National Cancer Institute's (NCI) Smokefree.gov website. DESIGN A two-arm stratified double-blind individually randomized trial (n = 1319 for WebQuit; n = 1318 for Smokefree.gov) with 12-month follow-up. SETTING United States. PARTICIPANTS Adults (n = 2637) who currently smoked at least five cigarettes per day were recruited from March 2014 to August 2015. At baseline, participants were mean [standard deviation (SD)] age 46.2 years (13.4), 79% women and 73% white. INTERVENTIONS WebQuit.org website (experimental) provided ACT for smoking cessation; Smokefree.gov website (comparison) followed US Clinical Practice Guidelines for smoking cessation. MEASUREMENTS The primary outcome was self-reported 30-day point prevalence abstinence at 12 months. FINDINGS The 12-month follow-up data retention rate was 88% (2309 of 2637). The 30-day point prevalence abstinence rates at the 12-month follow-up were 24% (278 of 1141) for WebQuit.org and 26% (305 of 1168) for Smokefree.gov [odds ratio (OR) = 0.91; 95% confidence interval (CI) = 0.76, 1.10; P = 0.334] in the a priori complete case analysis. Abstinence rates were 21% (278 of 1319) for WebQuit.org and 23% (305 of 1318) for Smokefree.gov (OR = 0.89 (0.74, 1.07; P = 0.200) when missing cases were imputed as smokers. The Bayes factor comparing the primary abstinence outcome was 0.17, indicating 'substantial' evidence of no difference between groups. CONCLUSIONS WebQuit.org and Smokefree.gov had similar 30-day point prevalence abstinence rates at 12 months that were descriptively higher than those of prior published website-delivered interventions and telephone counselor-delivered interventions.
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Affiliation(s)
- Jonathan B. Bricker
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA, 98109, USA,University of Washington, Department of Psychology, Box 351525, Seattle, WA, 98195, USA
| | - Kristin E. Mull
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA, 98109, USA
| | - Jennifer B. McClure
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | - Noreen L. Watson
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA, 98109, USA
| | - Jaimee L. Heffner
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA, 98109, USA
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Mathiot H, Nugier A, Nguyen-Thanh V. [Impact of dissemination of a diet and physical activity pamphlet to 8th grade students in France]. SANTE PUBLIQUE 2018; 30:7-24. [PMID: 29589693 DOI: 10.3917/spub.181.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION "J'aime manger, j'aime bouger, le guide nutrition pour les adolescents", ("I love to eat and move, the nutrition pamphlet for teenagers"), which is one of the eight information guides of the French Nutritional and Health Programme, is distributed annually by Santé publique France, the national public health agency, to 8th grade students by their biology teachers. The aim of this study was to assess the impact of this dissemination plan and the way 8th grade students and biology teachers perceive the pamphlet. Teenagers' knowledge of the French Nutritional and Health Programme's recommendations was also assessed. METHODS This study was based on a mixed method and was conducted in 2015 on 432 8th grade students by face-to-face interviews at home and 20 8th grade biology teachers interviewed individually or during focus groups. RESULTS The pamphlet obtained a recognition score of 40% among young people, who mostly saw it during a course at high school. 30% of teenagers reported having read or only skimmed through it and more than three-quarters reported that they liked the pamphlet. Teenagers and teachers found the pamphlet clear and accessible and globally appreciated the content, but they considered that it could be modernized. CONCLUSION Systematic distribution of the guide to students of a specific school grade is an efficient strategy to reach a maximum number of young people. It should be continued in the future. Modernization of the guide and improved support to teachers to distribute the guide could improve the performance of the programme.
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Lu CC, Hsiao YC, Huang HW, Lin JY, Huang CL. Effects of a Nurse-Led, Stage-Matched, Tailored Program for Smoking Cessation in Health Education Centers: A Prospective, Randomized, Controlled Trial. Clin Nurs Res 2018; 28:812-829. [PMID: 29363339 DOI: 10.1177/1054773817754276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to examine the effectiveness of a stage-matched intervention performed at outpatient clinics. Participants were randomly assigned to an intervention group (IG) or usual care group (UCG). The trial was targeted on smoking patients with coronary heart disease or diabetes. After completing the 3-month intervention, both groups received a telephone follow-up at 6 months. This analysis showed that the outcomes of the IG for the 7-day point prevalence (PP) of abstinence (odds ratio [OR] = 2.00; p = .001) and 30-day PP (OR = 2.27; p = .004) at 6 months were significantly better than the UCG. Stage of change (OR = 4.06; p < .001) and decreased daily cigarette consumption by 50% at 6 months (OR = 2.26; p = .019) outcomes also improved significantly. The preliminary results showed that a nurse-led cessation intervention in clinics may be an effective approach to help outpatients quit smoking.
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Affiliation(s)
- Chia-Chen Lu
- 1 Changhua Christian Hospital Erlin Branch, Taiwan
| | - Yu-Chuan Hsiao
- 2 Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Hui-Wen Huang
- 3 Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Jhen-Yi Lin
- 1 Changhua Christian Hospital Erlin Branch, Taiwan
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Hagens P, Pieterse M, van der Valk P, van der Palen J. Effectiveness of intensive smoking reduction counselling plus combination nicotine replacement therapy in promoting long-term abstinence in patients with chronic obstructive pulmonary disease not ready to quit smoking: Protocol of the REDUQ trial. Contemp Clin Trials Commun 2017; 8:248-257. [PMID: 29696216 PMCID: PMC5898473 DOI: 10.1016/j.conctc.2017.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 08/19/2017] [Accepted: 08/24/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Limited tobacco dependence treatment resources exist for smoking COPD patients not ready to quit. Smoking reduction may be a viable treatment approach if it prompts quit attempts and subsequent abstinence. This article describes the protocol of the REDUQ (REDUce and Quit) study, which examines whether smoking reduction counselling plus combination nicotine replacement therapy (NRT) is (cost-)effective in achieving long-term abstinence in smoking COPD patients not ready to quit. METHODS/DESIGN We conducted a two-centre, parallel-group, randomised controlled trial with 18 months follow-up in smoking outpatients with COPD. Patients not ready to quit within the next month but willing to reduce their smoking, were randomised to receive either intensive smoking reduction counselling plus combination NRT or a single information meeting plus self-help manual. Outcomes were assessed at baseline, 6, 12 and 18 months. The primary outcome is ≥ 1-year prolonged abstinence. Secondary outcomes are point prevalence abstinence, successful (i.e. ≥ 50%) smoking reduction, and incidence of quit attempts reported at follow-up assessments. Smoking status is biochemically verified by salivary cotinine and expired CO. Other variables include smoking-related cognitions, intention and motivation to reduce and quit smoking, withdrawal symptoms, health-related quality of life, symptoms of anxiety and depression, state of mindfulness, lung function, use of health care resources, and costs. DISCUSSION The outcomes of the REDUQ trial will advance knowledge on treatment of smoking COPD patients not ready to quit. If (cost-)effective, the smoking reduction intervention can be offered to this difficult-to-treat target group as a valuable adjunct to smoking cessation treatment.
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Affiliation(s)
- Petra Hagens
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, The Netherlands
| | - Marcel Pieterse
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, The Netherlands
| | - Paul van der Valk
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
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Bar-Zeev Y, Bovill M, Bonevski B, Gruppetta M, Reath J, Gould GS. Assessing and Validating an Educational Resource Package for Health Professionals to Improve Smoking Cessation Care in Aboriginal and Torres Strait Islander Pregnant Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1148. [PMID: 28961160 PMCID: PMC5664649 DOI: 10.3390/ijerph14101148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 09/18/2017] [Accepted: 09/25/2017] [Indexed: 11/16/2022]
Abstract
Australian Aboriginal pregnant women have a high smoking prevalence (45%). Health professionals lack adequate educational resources to manage smoking. Resources need to be tailored to ensure saliency, cultural-sensitivity and account for diversity of Indigenous populations. As part of an intervention to improve health professionals' smoking cessation care in Aboriginal pregnant women, a resource package was developed collaboratively with two Aboriginal Medical Services. The purpose of this study was to assess and validate this resource package. A multi-centred community-based participatory 4-step process (with three Aboriginal Medical Services from three Australian states), included: (1) Scientific review by an expert panel (2) 'Suitability of Materials' scoring by two Aboriginal Health Workers (3) Readability scores (4) Focus groups with health professionals. Content was analysed using six pre-determined themes (attraction, comprehension, self-efficacy, graphics and layout, cultural acceptability, and persuasion), with further inductive analysis for emerging themes. Suitability of Material scoring was adequate or superior. Average readability was grade 6.4 for patient resources (range 5.1-7.2), and 9.8 for health provider resources (range 8.5-10.6). Emergent themes included 'Getting the message right'; 'Engaging with family'; 'Needing visual aids'; and 'Requiring practicality under a tight timeframe'. Results were presented back to a Stakeholder and Consumer Aboriginal Advisory Panel and resources were adjusted accordingly. This process ensured materials used for the intervention were culturally responsive, evidence-based and useful. This novel formative evaluation protocol could be adapted for other Indigenous and culturally diverse interventions. The added value of this time-consuming and costly process is yet to be justified in research, and might impact the potential adaption by other projects.
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Affiliation(s)
- Yael Bar-Zeev
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Michelle Bovill
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Maree Gruppetta
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Jennifer Reath
- Department of General Practice, Western Sydney University, Campbelltown, NSW 2560, Australia.
| | - Gillian S Gould
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia.
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Kassavou A, Sutton S. Automated telecommunication interventions to promote adherence to cardio-metabolic medications: meta-analysis of effectiveness and meta-regression of behaviour change techniques. Health Psychol Rev 2017; 12:25-42. [PMID: 28805162 DOI: 10.1080/17437199.2017.1365617] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Automated telecommunication interventions, including short message service and interactive voice response, are increasingly being used to promote adherence to medications prescribed for cardio-metabolic conditions. This systematic review aimed to comprehensively assess the effectiveness of such interventions to support medication adherence, and to identify the behaviour change techniques (BCTs) and other intervention characteristics that are positively associated with greater intervention effectiveness. Meta-analysis of 17 randomised controlled trials showed a small but statistically significant effect on medication adherence, OR = 1.89, 95% CI [1.51, 2.36], I2 = 89%, N = 25,101. Multivariable meta-regression analysis including eight BCTs explained 88% of the observed variance in effect size (ES). The BCTs 'tailored' and 'information about health consequences' were positively and significantly associated with ES. Future studies could explore whether the inclusion of these and/or additional techniques (e.g., 'implementation intentions') would increase the effect of automated telecommunication interventions, using rigorous designs and objective outcome measures.
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Affiliation(s)
| | - Stephen Sutton
- a Behavioural Science Group , University of Cambridge , Cambridge , UK
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Taylor GMJ, Dalili MN, Semwal M, Civljak M, Sheikh A, Car J. Internet-based interventions for smoking cessation. Cochrane Database Syst Rev 2017; 9:CD007078. [PMID: 28869775 PMCID: PMC6703145 DOI: 10.1002/14651858.cd007078.pub5] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tobacco use is estimated to kill 7 million people a year. Nicotine is highly addictive, but surveys indicate that almost 70% of US and UK smokers would like to stop smoking. Although many smokers attempt to give up on their own, advice from a health professional increases the chances of quitting. As of 2016 there were 3.5 billion Internet users worldwide, making the Internet a potential platform to help people quit smoking. OBJECTIVES To determine the effectiveness of Internet-based interventions for smoking cessation, whether intervention effectiveness is altered by tailoring or interactive features, and if there is a difference in effectiveness between adolescents, young adults, and adults. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, which included searches of MEDLINE, Embase and PsycINFO (through OVID). There were no restrictions placed on language, publication status or publication date. The most recent search was conducted in August 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs). Participants were people who smoked, with no exclusions based on age, gender, ethnicity, language or health status. Any type of Internet intervention was eligible. The comparison condition could be a no-intervention control, a different Internet intervention, or a non-Internet intervention. To be included, studies must have measured smoking cessation at four weeks or longer. DATA COLLECTION AND ANALYSIS Two review authors independently assessed and extracted data. We extracted and, where appropriate, pooled smoking cessation outcomes of six-month follow-up or more, reporting short-term outcomes narratively where longer-term outcomes were not available. We reported study effects as a risk ratio (RR) with a 95% confidence interval (CI).We grouped studies according to whether they (1) compared an Internet intervention with a non-active control arm (e.g. printed self-help guides), (2) compared an Internet intervention with an active control arm (e.g. face-to-face counselling), (3) evaluated the addition of behavioural support to an Internet programme, or (4) compared one Internet intervention with another. Where appropriate we grouped studies by age. MAIN RESULTS We identified 67 RCTs, including data from over 110,000 participants. We pooled data from 35,969 participants.There were only four RCTs conducted in adolescence or young adults that were eligible for meta-analysis.Results for trials in adults: Eight trials compared a tailored and interactive Internet intervention to a non-active control. Pooled results demonstrated an effect in favour of the intervention (RR 1.15, 95% CI 1.01 to 1.30, n = 6786). However, statistical heterogeneity was high (I2 = 58%) and was unexplained, and the overall quality of evidence was low according to GRADE. Five trials compared an Internet intervention to an active control. The pooled effect estimate favoured the control group, but crossed the null (RR 0.92, 95% CI 0.78 to 1.09, n = 3806, I2 = 0%); GRADE quality rating was moderate. Five studies evaluated an Internet programme plus behavioural support compared to a non-active control (n = 2334). Pooled, these studies indicated a positive effect of the intervention (RR 1.69, 95% CI 1.30 to 2.18). Although statistical heterogeneity was substantial (I2 = 60%) and was unexplained, the GRADE rating was moderate. Four studies evaluated the Internet plus behavioural support compared to active control. None of the studies detected a difference between trial arms (RR 1.00, 95% CI 0.84 to 1.18, n = 2769, I2 = 0%); GRADE rating was moderate. Seven studies compared an interactive or tailored Internet intervention, or both, to an Internet intervention that was not tailored/interactive. Pooled results favoured the interactive or tailored programme, but the estimate crossed the null (RR 1.10, 95% CI 0.99 to 1.22, n = 14,623, I2 = 0%); GRADE rating was moderate. Three studies compared tailored with non-tailored Internet-based messages, compared to non-tailored messages. The tailored messages produced higher cessation rates compared to control, but the estimate was not precise (RR 1.17, 95% CI 0.97 to 1.41, n = 4040), and there was evidence of unexplained substantial statistical heterogeneity (I2 = 57%); GRADE rating was low.Results should be interpreted with caution as we judged some of the included studies to be at high risk of bias. AUTHORS' CONCLUSIONS The evidence from trials in adults suggests that interactive and tailored Internet-based interventions with or without additional behavioural support are moderately more effective than non-active controls at six months or longer, but there was no evidence that these interventions were better than other active smoking treatments. However some of the studies were at high risk of bias, and there was evidence of substantial statistical heterogeneity. Treatment effectiveness in younger people is unknown.
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Affiliation(s)
- Gemma M. J. Taylor
- University of BristolMRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology12a Priory RoadBristolUKBS8 1TU
| | | | - Monika Semwal
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)SingaporeSingapore
| | | | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of EdinburghAllergy & Respiratory Research Group and Asthma UK Centre for Applied ResearchTeviot PlaceEdinburghUKEH8 9AG
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)SingaporeSingapore
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
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Sloan M, Hopewell S, Coleman T, Cooper S, Naughton F. Smoking Cessation Support by Text Message During Pregnancy: A Qualitative Study of Views and Experiences of the MiQuit Intervention. Nicotine Tob Res 2017; 19:572-577. [PMID: 28403457 PMCID: PMC5896448 DOI: 10.1093/ntr/ntw241] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/22/2016] [Indexed: 11/17/2022]
Abstract
Introduction: SMS text messaging is increasingly used for delivering smoking cessation support and pilot studies suggest this may also be useful in pregnancy. This study explores the views of women who received a tailored text messaging cessation intervention (MiQuit) during pregnancy, focusing on acceptability, perceived impact, and suggestions for improvements. Methods: Semi-structured interviews were undertaken with 15 purposively sampled women who had received the MiQuit intervention during pregnancy as part of a randomized controlled trial. Data were analyzed thematically. Results: Three main themes were identified: “impact”, “approach,” and “optimization.” Participants described an immediate, yet often short-lived, impact from the texts that distracted and delayed them from smoking and they perceived that texts focusing on the development of and risk to the baby generated more enduring emotional impacts. Most women found receiving support by text preferable to face-to-face cessation support, with participants citing the greater regularity, convenience, and non-judgmental style as particular advantages. Participants would have preferred a longer support program with increased tailoring, greater customization of text timings and consideration of cutting down as an alternative/precursor to quitting. Conclusion: Pregnancy-specific cessation support by text message was well received and participants considered the support increased their motivation to stop smoking. The focus on the developing baby, the regularity of contact and the provision of gentle, encouraging messages were highlighted as particularly important elements of the program. Implications: This study adds further evidence to the acceptability and perceived positive impact of text-messaging programs in aiding smoking cessation in pregnancy. The findings indicate that for some women, this type of support is preferable to face-to-face methods and could be utilized by health professionals, either in addition to current methods or as an alternative. This study is also relevant to researchers developing health-related text programs to consider participants’ desire for greater tailoring. Further research is required into adapting and continuing text support for women postpartum.
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Affiliation(s)
- Melanie Sloan
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Sarah Hopewell
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Felix Naughton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, UK
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West R. Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychol Health 2017; 32:1018-1036. [PMID: 28553727 PMCID: PMC5490618 DOI: 10.1080/08870446.2017.1325890] [Citation(s) in RCA: 295] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 04/27/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite reductions in prevalence in recent years, tobacco smoking remains one of the main preventable causes of ill-health and premature death worldwide. This paper reviews the extent and nature of harms caused by smoking, the benefits of stopping, patterns of smoking, psychological, pharmacological and social factors that contribute to uptake and maintenance of smoking, the effectiveness of population and individual level interventions aimed at combatting tobacco smoking, and the effectiveness of methods used to reduce the harm caused by continued use of tobacco or nicotine in some form. RESULTS AND CONCLUSIONS Smoking behaviour is maintained primarily by the positive and negative reinforcing properties of nicotine delivered rapidly in a way that is affordable and palatable, with the negative health consequences mostly being sufficiently uncertain and distant in time not to create sufficient immediate concern to deter the behaviour. Raising immediate concerns about smoking by tax increases, social marketing and brief advice from health professionals can increase the rate at which smokers try to stop. Providing behavioural and pharmacological support can improve the rate at which those quit attempts succeed. Implementing national programmes containing these components are effective in reducing tobacco smoking prevalence and reducing smoking-related death and disease.
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Affiliation(s)
- Robert West
- Department of Behavioural Science and Health, University College London, London, UK
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35
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Tzelepis F, Paul CL, Williams CM, Gilligan C, Regan T, Daly J, Hodder RK, Wiggers J. Real-time video counselling for smoking cessation. Hippokratia 2017. [DOI: 10.1002/14651858.cd012659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Flora Tzelepis
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Christine L Paul
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
| | - Christopher M Williams
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Conor Gilligan
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
| | - Tim Regan
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Justine Daly
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - Rebecca K Hodder
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
| | - John Wiggers
- University of Newcastle; School of Medicine and Public Health; University Drive Callaghan NSW Australia 2308
- Hunter Medical Research Institute; New Lambton Australia
- Hunter New England Local Health District; Hunter New England Population Health; Wallsend Australia
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Abstract
BACKGROUND Individual counselling from a smoking cessation specialist may help smokers to make a successful attempt to stop smoking. OBJECTIVES The review addresses the following hypotheses:1. Individual counselling is more effective than no treatment or brief advice in promoting smoking cessation.2. Individual counselling is more effective than self-help materials in promoting smoking cessation.3. A more intensive counselling intervention is more effective than a less intensive intervention. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register for studies with counsel* in any field in May 2016. SELECTION CRITERIA Randomized or quasi-randomized trials with at least one treatment arm consisting of face-to-face individual counselling from a healthcare worker not involved in routine clinical care. The outcome was smoking cessation at follow-up at least six months after the start of counselling. DATA COLLECTION AND ANALYSIS Both authors extracted data in duplicate. We recorded characteristics of the intervention and the target population, method of randomization and completeness of follow-up. We used the most rigorous definition of abstinence in each trial, and biochemically-validated rates where available. In analysis, we assumed that participants lost to follow-up continued to smoke. We expressed effects as a risk ratio (RR) for cessation. Where possible, we performed meta-analysis using a fixed-effect (Mantel-Haenszel) model. We assessed the quality of evidence within each study using the Cochrane 'Risk of bias' tool and the GRADE approach. MAIN RESULTS We identified 49 trials with around 19,000 participants. Thirty-three trials compared individual counselling to a minimal behavioural intervention. There was high-quality evidence that individual counselling was more effective than a minimal contact control (brief advice, usual care, or provision of self-help materials) when pharmacotherapy was not offered to any participants (RR 1.57, 95% confidence interval (CI) 1.40 to 1.77; 27 studies, 11,100 participants; I2 = 50%). There was moderate-quality evidence (downgraded due to imprecision) of a benefit of counselling when all participants received pharmacotherapy (nicotine replacement therapy) (RR 1.24, 95% CI 1.01 to 1.51; 6 studies, 2662 participants; I2 = 0%). There was moderate-quality evidence (downgraded due to imprecision) for a small benefit of more intensive counselling compared to brief counselling (RR 1.29, 95% CI 1.09 to 1.53; 11 studies, 2920 participants; I2 = 48%). None of the five other trials that compared different counselling models of similar intensity detected significant differences. AUTHORS' CONCLUSIONS There is high-quality evidence that individually-delivered smoking cessation counselling can assist smokers to quit. There is moderate-quality evidence of a smaller relative benefit when counselling is used in addition to pharmacotherapy, and of more intensive counselling compared to a brief counselling intervention.
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Affiliation(s)
- Tim Lancaster
- King’s College LondonGKT School of Medical EducationLondonUK
| | - Lindsay F Stead
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Cheung YTD, Wang MP, Li HCW, Kwong A, Lai V, Chan SSC, Lam TH. Effectiveness of a small cash incentive on abstinence and use of cessation aids for adult smokers: A randomized controlled trial. Addict Behav 2017; 66:17-25. [PMID: 27863323 DOI: 10.1016/j.addbeh.2016.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Large amount of financial incentive was effective to increase tobacco abstinence, but the effect of small amount is unknown. PURPOSE We evaluated if a small amount of cash incentive (HK$500/US$64) increased abstinence, quit attempt, and use of cessation aids. METHODS A three-armed, block randomized controlled trial recruited 1143 adult daily smokers who participated in the Hong Kong "Quit to Win" Contest. Biochemically validated quitters of the early-informed (n=379, notified about the incentive at 1-week and 1-month follow-up) and the late-informed incentive group (n=385, notified at 3-month follow-up) received the incentive at 3months. The validated quitters of the control group (n=379) received the incentive at 6months without prior notification. All subjects received brief advice, a self-help education card and a 12-page booklet. The outcomes were self-reported 7-day point prevalence of abstinence, quit attempt (intentional abstinence for at least 24h) and use of cessation aids at 3-month follow-up. RESULTS By intention-to-treat, the early-informed group at 3-month follow-up reported a higher rate of quit attempt (no smoking for at least 24h) than the other 2 groups (44.1% vs. 37.4%, Odds ratio (OR)=1.32, 95% CI 1.03-1.69, p=0.03), but they had similar abstinence (9.2% vs. 9.7%, OR=0.95, 95% CI 0.62, 1.45). The early- and late-informed group showed similar quitting outcomes. The early-informed group reported more quit attempts by reading self-help materials than the other 2 groups (31.4% vs. 25.3%, OR=1.56, 95% CI 1.12-2.18, p<0.01). CONCLUSIONS The small cash incentive with early notification increased quit attempt by "self-directed help" but not abstinence. Future financial incentive-based programmes with a larger incentive, accessible quitting resources and encouragement of using existing smoking cessation services are needed.
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Affiliation(s)
- Yee Tak Derek Cheung
- School of Public Health, The University of Hong Kong, Hong Kong; School of Nursing, The University of Hong Kong, Hong Kong.
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | | | - Vienna Lai
- Hong Kong Council on Smoking and Health, Hong Kong
| | | | - Tai-Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
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Gilbert H, Sutton S, Morris R, Petersen I, Galton S, Wu Q, Parrott S, Nazareth I. Effectiveness of personalised risk information and taster sessions to increase the uptake of smoking cessation services (Start2quit): a randomised controlled trial. Lancet 2017; 389:823-833. [PMID: 28129989 PMCID: PMC5357975 DOI: 10.1016/s0140-6736(16)32379-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/18/2016] [Accepted: 10/25/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND National Health Service Stop Smoking Services (SSSs) offer help to smokers motivated to quit; however, attendance rates are low and recent figures show a downward trend. We aimed to assess the effectiveness of a two-component personalised intervention on attendance at SSSs. METHODS We did this randomised controlled trial in 18 SSSs in England. Current smokers (aged ≥16 years) were identified from medical records in 99 general practices and invited to participate by their general practitioner. Individuals who gave consent, were motivated to quit, and had not attended the SSS within the past 12 months, were randomly assigned (3:2), via computer-generated randomisation with permuted blocks (block size of five), to receive either an individually tailored risk letter and invitation to attend a no-commitment introductory session run by the local SSS (intervention group) or a standard generic letter advertising the local SSS (control group). Randomisation was stratified by sex. Masking of participants to receipt of a personal letter and invitation to a taster session was not possible. The personal letter was generated by a research assistant, but the remainder of the research team were masked to group allocation. General practitioners, practice staff, and SSS advisers were unaware of their patients' allocation. The primary outcome was attendance at the first session of an SSS course within 6 months from randomisation. We did analysis by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN 76561916. FINDINGS Recruitment, collection of baseline data, delivery of the intervention, and follow up of participants took place between Jan 31, 2011, and July 12, 2014. We randomly assigned 4384 smokers to the intervention group (n=2636) or the control group (n=1748); 4383 participants comprised the intention-to-treat population. Attendance at the first session of an SSS course was significantly higher in the intervention group than in the control group (458 [17·4%] vs 158 [9·0%] participants; unadjusted odds ratio 2·12 [95% CI 1·75-2·57]; p<0·0001). INTERPRETATION Delivery of personalised risk information alongside an invitation to an introductory session more than doubled the odds of attending the SSS compared with a standard generic invitation to contact the service. This result suggests that a more proactive approach, combined with an opportunity to experience local services, can reduce patient barriers to receiving treatment and has high potential to increase uptake. FUNDING National Institutes of Health Research Health Technology Assessment.
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Affiliation(s)
- Hazel Gilbert
- Research Department of Primary Care and Population Health, UCL, London, UK.
| | - Stephen Sutton
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Richard Morris
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - Simon Galton
- Smokefree Camden (Public Health), NHS Camden, London, UK
| | - Qi Wu
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Irwin Nazareth
- Research Department of Primary Care and Population Health, UCL, London, UK
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Chamberlain C, O'Mara‐Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2017; 2:CD001055. [PMID: 28196405 PMCID: PMC6472671 DOI: 10.1002/14651858.cd001055.pub5] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors. SELECTION CRITERIA Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, with meta-regression conducted in STATA 14. MAIN RESULTS The overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.In separate comparisons, there is high-quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small.Evidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention.There was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20).High-quality evidence suggests incentive-based interventions are effective when compared with an alternative (non-contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I2 = 93%).High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health.The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32).Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions.The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions. AUTHORS' CONCLUSIONS Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update.
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Affiliation(s)
- Catherine Chamberlain
- La Trobe UniversityJudith Lumley Centre251 Faraday StreetMelbourneVicAustralia3000
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - Alison O'Mara‐Eves
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Jessie Porter
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
| | - Tim Coleman
- University of NottinghamDivision of Primary CareD1411, Medical SchoolQueen's Medical CentreNottinghamUKNG7 2UH
| | - Susan M Perlen
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Joanne E McKenzie
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
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Crocamo C, Carretta D, Ferri M, Dias S, Bartoli F, Carrá G. Web- and text-based interventions for smoking cessation: Meta-analysis and meta-regression. DRUGS: EDUCATION, PREVENTION AND POLICY 2017. [DOI: 10.1080/09687637.2017.1285867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca , Monza, Italy,
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia , Pavia, Italy,
| | - Daniele Carretta
- Department of Medicine and Surgery, University of Milano Bicocca , Monza, Italy,
| | | | - Sonia Dias
- Istituto de Higiene e Medician Tropical Universidade Nova de Lisboa , Lisbon, Portugal, and
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca , Monza, Italy,
| | - Giuseppe Carrá
- Division of Psychiatry, Faculty of Brain Sciences, University College of London , London, UK
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Use of aids for smoking cessation and alcohol reduction: A population survey of adults in England. BMC Public Health 2016; 16:1237. [PMID: 27931202 PMCID: PMC5146832 DOI: 10.1186/s12889-016-3862-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 11/22/2016] [Indexed: 02/04/2023] Open
Abstract
Background It is important for policy planning to chart the methods smokers and high-risk drinkers use to help them change their behaviour. This study assessed prevalence of use, and characteristics of users, of support for smoking cessation and alcohol reduction in England. Methods Data were used from the Smoking and Alcohol Toolkit Studies, which involve monthly face-to-face computer-assisted interviews of adults aged 16+ in England. We included data collected between June 2014 and July 2015 on 1600 smokers who had made at least one quit attempt and 911 high-risk drinkers (defined as scores >8+ on the full AUDIT or 5+ on questions 1–3 of the AUDIT-C) who had made an attempt to cut down in the past 12 months. Participants provided information on their socio-demographic characteristics and use of aids during their most recent quit attempt including pharmacotherapy, face-to-face counselling, telephone support, self-help materials (digital and printed), and complementary medicine. Results A total of 60.3% of smokers used aids in the past year, compared with just 14.9% of high-risk drinkers. Use of pharmacotherapy was high among smokers and very low among drinkers (56.0%versus1.2%). Use of other aids was low for both behaviours: face-to-face counselling (2.6%versus4.8%), self-help materials (1.4%versus4.1%) and complementary medicine (1.0%versus0.5%). Use of aids was more common among smokers aged 25–54 compared with 16–24 year olds (25–34,ORadj1.49,p = 0.012; 35–44,ORadj1.93,p < 0.001; 35–44,ORadj1.93,p < 0.001; 45–54,ORadj1.66,p = 0.008), with cigarette consumption >10 relative to <1 (10–20,ORadj2.47,p = 0.011; >20,ORadj4.23,p = 0.001), and less common among ethnic minorities (ORadj0.69,p = 0.026). For alcohol reduction, use of aids was higher among ethnic minority groups (ORadj2.41;p = 0.015), and those of social-grade D/E relative to AB (ORadj2.29,p = 0.012&ORadj3.13,p < 0.001). Conclusion In England, the use of pharmacotherapy is prevalent for smoking cessation but not alcohol reduction. Other aids are used at a low rate, with face-to-face counselling being more common for alcohol reduction than smoking cessation. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3862-7) contains supplementary material, which is available to authorized users.
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Choice of smoking cessation counselling via phone, text, or email in emergency department patients. Prev Med Rep 2016; 4:597-600. [PMID: 27843760 PMCID: PMC5107645 DOI: 10.1016/j.pmedr.2016.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/14/2016] [Accepted: 10/24/2016] [Indexed: 11/23/2022] Open
Abstract
Globally, tobacco smoke is the leading cause of preventable deaths. Smoking cessation counselling services are widely available in Canada. In British Columbia, our government-funded smoking cessation service offers counselling via phone, text, or email. In this study, we sought to determine whether age, gender, or motivation to quit affect a patient's choice of service modality. We included all adults ≥ 18 years who had used tobacco within 30 days prior to their Emergency Department (ED) visit and who chose to receive phone, text, or email counselling services from November 2011–February 2013 at Vancouver General Hospital as part of a randomized-controlled trial (ClinicalTrials.gov, NCT0145437). A one-way ANOVA was used to compare the mean age of patients in each group. Chi-squared tests of independence were used to determine if gender or motivation to quit were associated with modality selection. In total, 368 patients were included. The average age was 41.7 years and 67% were female. In our study, 44% chose phone, 17% chose text, and 40% chose email services. The average age for patients preferring text services (mean = 33.6 years) was significantly lower than both the email (mean = 41.3 years) and phone (mean = 45.1 years) groups (p < 0.001). Gender and motivation to quit were not associated with service modality choice. Over 80% of ED smokers who accepted a referral to counselling services chose the phone or email modality. The lesser chosen text modality was more popular with younger patients. With further research, smoking cessation counselling services can refine their programs to meet the needs of the population they serve. Many smoking cessation quit lines offer counselling by phone, text, or internet. > 80% of smokers in our study who accepted referral chose phone or internet counselling. The lesser chosen text referral modality was more popular with younger patients. Smoking cessation counselling services should work to meet their demographic's needs. Counselling services that text should know they may attract a younger population.
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Meyer C, Ulbricht S, Haug S, Broda A, Bischof G, Rumpf HJ, John U. Motivating smokers to quit using computer-generated letters that target either reduction or cessation: A population-based randomized controlled trial among smokers who do not intend to quit. Drug Alcohol Depend 2016; 166:177-86. [PMID: 27449274 DOI: 10.1016/j.drugalcdep.2016.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 07/07/2016] [Accepted: 07/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study examined the long-term efficacy of individualized counseling letters that targeted either smoking abstinence or reducing the number of cigarettes smoked per day to promote future cessation. METHODS A nationwide random-digit-dialing telephone sample was used to identify smokers from the general adult population (participation proportion: 54.5%). In total, 1462 participants (48% female) who did not intend to quit within the next six months and who smoked ten or more cigarettes a day were randomized to one of two intervention groups or an assessment-only control condition. The interventions consisted of three tailored letters that were sent after baseline and follow-up assessments after three and six months. Follow-up data on smoking status were provided by 82% and 77% of the participants 12 and 24 months after study inclusion, respectively. Generalized estimation equation (GEE) models adjusted for potential baseline confounders and multiple imputation of missing follow-up data were used to estimate intervention effects. RESULTS At 24-month follow-up prevalence of 7-day point abstinence was 8.4%, 12.9% and 14.7% in the control, abstinence intervention and reduction intervention condition, which corresponds to a number needed to treat of 22 (95%-CI: 11-707) and 16 (95%-CI: 9-53). Adjusted GEE analyses revealed that the smoking reduction intervention (ORadj=2.3, p<0.01) but not the abstinence intervention (ORadj=1.4, p=0.20) increased the odds of 6-month prolonged abstinence compared with the control condition. No significant differences appear when directly comparing both intervention groups. CONCLUSION Smoking reduction should be considered as an alternative intervention goal for smokers who are unable or unwilling to quit.
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Affiliation(s)
- Christian Meyer
- Department of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany; Partner site Greifswald, DZHK (German Centre for Cardiovascular Research), Greifswald, Germany.
| | - Sabina Ulbricht
- Department of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany; Partner site Greifswald, DZHK (German Centre for Cardiovascular Research), Greifswald, Germany
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction at Zurich University, Zürich, Switzerland
| | - Anja Broda
- Institute of Health and Nursing Sciences, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Gallus Bischof
- Research Group S:TEP, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Hans-Jürgen Rumpf
- Research Group S:TEP, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Ulrich John
- Department of Social Medicine and Prevention, University Medicine Greifswald, Greifswald, Germany; Partner site Greifswald, DZHK (German Centre for Cardiovascular Research), Greifswald, Germany
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Williams JM, Steinberg ML, Kenefake AN, Burke MV. An Argument for Change in Tobacco Treatment Options Guided by the ASAM Criteria for Patient Placement. J Addict Med 2016; 10:291-9. [PMID: 27466070 PMCID: PMC5049967 DOI: 10.1097/adm.0000000000000239] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 06/02/2016] [Indexed: 11/26/2022]
Abstract
Tobacco use is a major threat to public health in the United States, and the number one cause of preventable death. Although most smokers try to quit unaided, robust data indicate that pairing behavioral support to US Food Drug Administration-approved cessation medications significantly increase cessation rates. Those who do receive assistance in quitting usually receive very low intensity treatment, regardless of the severity of their dependence or their medical and environmental circumstances. This is in stark contrast to how other substance use disorders are treated, where there are varying levels of care depending on addiction severity and biopsychosocial circumstances. The American Society of Addiction Medicine (ASAM) developed a formal algorithm for assessing substance use disorders and determining the optimal level of care. The ASAM Patient Placement Criteria are regularly used to determine the appropriate level of care for all substance use disorders except tobacco. This paper will review key aspects of the ASAM dimensions of care and placement levels, with emphasis on how they apply to tobacco use and present case examples of typical smokers who would benefit from a higher intensity of tobacco dependence treatment. We also present current barriers to reimbursing healthcare providers for these services. We conclude with a commentary and discussion regarding recommendations for improvements in tobacco dependence treatment care.
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Affiliation(s)
- Jill M Williams
- Rutgers Robert Wood Johnson Medical School (JMW, MLS, ANK), New Brunswick, NJ; and Mayo Medical Center, Rochester, MN (MVB)
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Fan H, Song F, Gu H, Wang J, Jia G, Lu M, Qian J, Wang L, Shen J, Ren Z. An assessment of factors associated with quality of randomized controlled trials for smoking cessation. Oncotarget 2016; 7:53762-53771. [PMID: 27449103 PMCID: PMC5288219 DOI: 10.18632/oncotarget.10742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/10/2016] [Indexed: 11/25/2022] Open
Abstract
To reduce smoking-related diseases, a research priority is to develop effective interventions for smoking cessation, and evidence from randomized controlled trials (RCTs) is usually considered to be the most valid. However, findings from RCTs may still be misleading due to methodological flaws. This study aims to assess the quality of 1083 RCTs of smoking cessation interventions in 41 relevant Cochrane Systematic Reviews (CSRs). Logistic regression analysis was performed to identify significant variables associated with the quality of RCTs. It was found that evidence for smoking cessation from RCTs was predominantly from high income countries, and the overall quality was high in only 8.6% of the RCTs. High quality RCTs tended to have a larger sample size, to be more recently published, and conducted in multiple countries belonging to different income categories. In conclusion, the overall quality of RCTs of smoking cessation interventions is far from perfect, and more RCTs in less developed countries are required to generate high grade evidence for global tobacco control. Collaboration between researchers in developed and less developed countries should be encouraged.
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Affiliation(s)
- Hong Fan
- Center for Health Policy and Management Research, Nanjing University, Nanjing, P.R.China
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Fujian Song
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Hai Gu
- Center for Health Policy and Management Research, Nanjing University, Nanjing, P.R.China
| | - Jianming Wang
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Guizhen Jia
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Moyuan Lu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Jiao Qian
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Lei Wang
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Jiemiao Shen
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Zhewen Ren
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
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Olano-Espinosa E, Minué-Lorenzo C. ["Do not do" also as regards tobacco]. Aten Primaria 2016; 48:493-9. [PMID: 27209564 PMCID: PMC6877859 DOI: 10.1016/j.aprim.2016.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 11/16/2022] Open
Abstract
We do have very effective and efficient interventions to help our patients to stop smoking. The strategy that has more evidence and consensus in primary care is the 5 A's, that is, ask, advise, assess willingness to try to quit smoking, helping those who want to try and make follow-up visits. However, we intervene lot less than we should. The available protocols oversized interventions, and propose elements without scientific evidence or therapeutic effect. It is therefore necessary to develop more simple, useful and evidence-based interventions to assist us in carrying out our work interventions, and stop doing those that dońt contribute. In this article we will use as an example a critical review of Smoker Care Service Portfolio of Madrid Health Service, and we will propose a number of alternatives to allow a simple, effective and evidence-based intervention.
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Affiliation(s)
- Eduardo Olano-Espinosa
- Centro de Salud Los Castillos, Alcorcón, Madrid, miembro del Grupo de Abordaje al Tabaquismo (GAT) de la Sociedad Madrileña de Medicina Familiar y Comunitaria (SoMaMFyC).
| | - César Minué-Lorenzo
- Centro de Salud Perales del Río, Getafe, Madrid, coordinador del Grupo de Abordaje al Tabaquismo (GAT) de la Sociedad Madrileña de Medicina Familiar y Comunitaria (SoMaMFyC)
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Brandon TH, Simmons VN, Sutton SK, Unrod M, Harrell PT, Meade CD, Craig BM, Lee JH, Meltzer LR. Extended Self-Help for Smoking Cessation: A Randomized Controlled Trial. Am J Prev Med 2016; 51:54-62. [PMID: 26868284 PMCID: PMC4914420 DOI: 10.1016/j.amepre.2015.12.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/09/2015] [Accepted: 12/24/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Far too few smokers receive recommended interventions at their healthcare visits, highlighting the importance of identifying effective, low-cost smoking interventions that can be readily delivered. Self-help interventions (e.g., written materials) would meet this need, but they have shown low efficacy. The purpose of this RCT was to determine the efficacy of a self-help intervention with increased duration and intensity. DESIGN Randomized parallel trial design involving enrollment between April 2010 and August 2011 with follow-up data for 24 months. SETTING/PARTICIPANTS U.S. national sample of daily smokers (N=1,874). INTERVENTION Participants were randomized to one of three arms of a parallel trial design: Traditional Self-Help (TSH, n=638), Standard Repeated Mailings (SRM, n=614), or Intensive Repeated Mailings (IRM, n=622). TSH received an existing self-help booklet for quitting smoking. SRM received eight different cessation booklets mailed over a 12-month period. IRM received monthly mailings of ten booklets and additional material designed to enhance social support over 18 months. MAIN OUTCOME MEASURES The primary outcome was 7-day point-prevalence abstinence collected at 6, 12, 18, and 24 months. RESULTS Data were analyzed between 2013 and 2015. A dose-response effect was found across all four follow-up points. For example, by 24 months, IRM produced the highest abstinence rate (30.0%), followed by SRM (24.4%) and TSH (18.9%). The difference in 24-month abstinence rates between IRM and TSH was 11.0% (95% CI=5.7%, 16.3%). Cost analyses indicated that, compared with TSH, the incremental cost per quitter who received SRM and IRM was $560 and $361, respectively. CONCLUSIONS Self-help interventions with increased intensity and duration resulted in significantly improved abstinence rates that extended 6 months beyond the end of the intervention. Despite the greater intensity, the interventions were highly cost effective, suggesting that widespread dissemination in healthcare settings could greatly enhance quitting. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01352195.
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Affiliation(s)
- Thomas H Brandon
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Marina Unrod
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Paul T Harrell
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia
| | - Cathy D Meade
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Benjamin M Craig
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ji-Hyun Lee
- Division of Epidemiology and Biostatistics, University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Lauren R Meltzer
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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How lay health workers tailor in effective health behaviour change interventions: a protocol for a systematic review. Syst Rev 2016; 5:102. [PMID: 27311303 PMCID: PMC4910188 DOI: 10.1186/s13643-016-0271-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lay health workers (LHWs) are utilised as a channel of delivery in many health interventions. While they have no formal professional training related to their role, they utilise their connections with the target group or community in order to reach individuals who would not normally readily engage with health services. Lay health worker programmes are often based on psychological theories of behaviour change that point to 'tailoring to individuals' needs or characteristics' as key to success. Although lay health workers have been shown to be effective in many contexts, there is, as yet, little clarity when it comes to how LHWs assess individuals' needs in order to tailor their interventions. This study aims to develop a better understanding of the effective implementation of tailoring in lay health worker interventions by appraising evidence and synthesising studies that report evaluations of tailored interventions. METHOD Health and psychology electronic databases (EMBASE, CINAHL, MEDLINE and PsycINFO) will be searched. Reference lists of included studies will also be searched. For articles that are deemed to be potentially relevant, we will employ a 'cluster searching' technique in order to identify all published papers related to a relevant intervention. Cluster searching will be undertaken in an effort to maximise the breadth and depth of description of the intervention. Quantitative studies will be assessed using the Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project, ON, Canada. Qualitative studies will be assessed using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. Sythesising the data will enable the development of a taxonomy of strategies for the criteria used for individual assessment of recipients' needs and the ways in which messages or actions are tailored to these individual criteria by LHWs. DISCUSSION This systematic review focuses specifically on how health promotion and support is individually tailored in effective programmes by LHWs. This study will be of value to those involved in the design and implementation of interventions that utilise a LHW. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015030071.
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Pool ERM, Dogar O, Lindsay RP, Weatherburn P, Siddiqi K. Interventions for tobacco use cessation in people living with HIV and AIDS. Cochrane Database Syst Rev 2016; 2016:CD011120. [PMID: 27292836 PMCID: PMC8604206 DOI: 10.1002/14651858.cd011120.pub2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tobacco use is highly prevalent amongst people living with HIV/AIDS (PLWHA) and has a substantial impact on morbidity and mortality. OBJECTIVES To assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO in June 2015. We also searched EThOS, ProQuest, four clinical trial registries, reference lists of articles, and searched for conference abstracts using Web of Science and handsearched speciality conference databases. SELECTION CRITERIA Controlled trials of behavioural or pharmacological interventions for tobacco cessation for PLWHA. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised electronic data collection form. They extracted data on the nature of the intervention, participants, and proportion achieving abstinence and they contacted study authors to obtain missing information. We collected data on long-term (greater than or equal to six months) and short-term (less than six months) outcomes. Where appropriate, we performed meta-analysis and estimated the pooled effects using the Mantel-Haenszel fixed-effect method. Two authors independently assessed and reported the risk of bias according to prespecified criteria. MAIN RESULTS We identified 14 studies relevant to this review, of which we included 12 in a meta-analysis (n = 2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy.There was moderate quality evidence from six studies for the long-term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.72 to 1.39) with no evidence of heterogeneity (I(2) = 0%). The pooled long-term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short-term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I(2) = 42%). Abstinence in the control group at short-term follow-up was 8% (n = 67/848) and in the intervention group was 13% (n = 118/937). The effect of tailoring the intervention for PLWHA was unclear. We further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. We failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study. AUTHORS' CONCLUSIONS There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long-term. There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short-term abstinence. Despite this, tobacco cessation interventions should be offered to PLWHA, since even non-sustained periods of abstinence have proven benefits. Further large, well designed studies of cessation interventions for PLWHA are needed.
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Affiliation(s)
- Erica RM Pool
- Brighton and Sussex University Hospitals NHS TrustBrightonUK
| | - Omara Dogar
- University of YorkDepartment of Health SciencesSeebohm Rowntree BuildingHeslingtonYorkUKYO10 5DD
| | - Ryan P Lindsay
- Idaho State UniversityDepartment of Community and Public HealthMeridianIdahoUSA
| | - Peter Weatherburn
- London School of Hygiene and Tropical MedicineSigma Research, Department of Social & Environmental Health ResearchLondonUK
| | - Kamran Siddiqi
- York UniversityDepartment of Health Sciences/Hull York Medical SchoolYorkUKYO10 5DD
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Brown J, Michie S, Walmsley M, West R. An Online Documentary Film to Motivate Quit Attempts Among Smokers in the General Population (4Weeks2Freedom): A Randomized Controlled Trial. Nicotine Tob Res 2016; 18:1093-100. [PMID: 26220547 PMCID: PMC4826487 DOI: 10.1093/ntr/ntv161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/17/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Online motivational films to promote quit attempts could encourage large numbers of smokers to stop at low unit cost. We evaluated an online film documenting the experiences of smokers who recorded the first month of their successful attempts to quit (4Weeks2Freedom). The film was designed to boost motivation and self-efficacy and provide role-models to promote ex-smoker identities. METHODS This was a randomized trial with individual assignment to a no-intervention control (n = 1016), an informational film (n = 1004), or 4Weeks2Freedom (n = 999). The development of 4Weeks2Freedom was informed by PRIME theory and focus-group testing with smokers. The 90-minute film was available online to view in one sitting or as chapters over 4 weeks to coincide with the progress of an attempt. The primary outcome was a quit attempt in the 4 weeks between assignment and study endpoint by intent-to-treat. RESULTS Participants smoked a mean of 13 cigarettes per day and 31% reported not wanting to stop. At follow-up, 55% reported viewing the informational control film and 56% viewing 4Weeks2Freedom. There was no detectable effect compared with the no-intervention control (OR = 0.99, 95% CI = 0.81 to 1.21, 24.3% vs. 24.5%) or informational control film (OR = 0.99, 95% CI = 0.80 to 1.21, 24.3% vs. 24.6%). Calculation of Bayes factors ruled out insensitive data and indicated the intervention was no more effective than either the no-intervention control (Bayes factor = 0.20) or informational control film (Bayes factor = 0.27). The pattern of results was unchanged in sensitivity analyses that examined the effect among only those who viewed the films. CONCLUSION The online documentary film (4Weeks2Freedom) designed to boost motivation and self-efficacy and to promote ex-smoker identity does not appear to prompt quit attempts among smokers. IMPLICATIONS This trial found that an online documentary film (4Weeks2Freedom) designed to boost motivation and self-efficacy and to promote ex-smoker identity was ineffective in prompting quit attempts among an unselected panel of smokers from the UK. This approach appears unpromising as a means of raising the rate at which smokers attempt to quit and is a low priority for future research.
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Affiliation(s)
- Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom;
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; National Centre for Smoking Cessation and Training, London, United Kingdom
| | | | - Robert West
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom; National Centre for Smoking Cessation and Training, London, United Kingdom
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