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Quinn-Scoggins HD, Murray RL, Quaife SL, Smith P, Brain KE, Callister MEJ, Baldwin DR, Britton J, Crosbie PAJ, Thorley R, McCutchan GM. Co-development of an evidence-based personalised smoking cessation intervention for use in a lung cancer screening context. BMC Pulm Med 2022; 22:478. [PMID: 36522781 PMCID: PMC9756588 DOI: 10.1186/s12890-022-02263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Optimising smoking cessation services within a low radiation-dose computed tomography (LDCT) lung cancer screening programme has the potential to improve cost-effectiveness and overall efficacy of the programme. However, evidence on the optimal design and integration of cessation services is limited. We co-developed a personalised cessation and relapse prevention intervention incorporating medical imaging collected during lung cancer screening. The intervention is designed to initiate and support quit attempts among smokers attending screening as part of the Yorkshire Enhanced Stop Smoking study (YESS: ISRCTN63825779). Patients and public were involved in the development of an intervention designed to meet the needs of the target population. METHODS An iterative co-development approach was used. Eight members of the public with a history of smoking completed an online survey to inform the visual presentation of risk information in subsequent focus groups for acceptability testing. Three focus groups (n = 13) were conducted in deprived areas of Yorkshire and South Wales with members of the public who were current smokers or recent quitters (within the last year). Exemplar images of the heart and lungs acquired by LDCT, absolute and relative lung cancer risk, and lung age were shown. Data were analysed thematically, and discussed in stakeholder workshops. Draft versions of the intervention were developed, underpinned by the Extended Parallel Processing Model to increase self-efficacy and response-efficacy. The intervention was further refined in a second stakeholder workshop with a patient panel. RESULTS Individual LDCT scan images of the lungs and heart, in conjunction with artistic impressions to facilitate interpretation, were considered by public participants to be most impactful in prompting cessation. Public participants thought it important to have a trained practitioner guiding them through the intervention and emphasising the short-term benefits of quitting. Presentation of absolute and relative risk of lung cancer and lung age were considered highly demotivating due to reinforcement of fatalistic beliefs. CONCLUSION An acceptable personalised intervention booklet utilising LDCT scan images has been developed for delivery by a trained smoking cessation practitioner. Our findings highlight the benefit of co-development during intervention development and the need for further evaluation of effectiveness.
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Affiliation(s)
- Harriet D Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Rachael L Murray
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Pamela Smith
- Division of Population Medicine, School of Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Kate E Brain
- Division of Population Medicine, School of Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Matthew E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospital, Nottingham, UK
| | - John Britton
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rebecca Thorley
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Grace M McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
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Thomas JL, Schreier M, Luo X, Lowry S, Hennrikus D, An L, Wetter DW, Ahluwalia JS. Promoting Smoke-Free Homes Through Biomarker Feedback Documenting Child Exposure to Tobacco Toxins: Protocol for a Randomized Clinical Trial. JMIR Res Protoc 2019; 8:e12654. [PMID: 31588910 PMCID: PMC6913685 DOI: 10.2196/12654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Exposure to secondhand smoke (SHS) early in life increases the risk of sudden infant death syndrome (SIDS), asthma, and respiratory illnesses. Since children's primary exposure to SHS occurs in the home, these most vulnerable members of our society are not fully protected by recent increases in the adoption of smoking bans in public spaces. Although exposure to SHS is a quickly reversible cause of excess morbidity, few low-income homes strictly enforce smoking restrictions. OBJECTIVE This study aims to test a novel approach to motivate the adoption of home smoking restrictions and to eliminate child SHS exposure by providing parents with objective data documenting home SHS exposure and "biomarker feedback" of child ingestion of tobacco toxins, that is, objective, laboratory-based results of assays performed on child urine, documenting levels of nicotine; cotinine; and NNAL (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol), which is a metabolite of the known tobacco carcinogen NNK (4-[methylnitro-samino]-1-[3-pyridyl]-1-butanone). METHODS From 2011 to 2013, 195 low-income, female smokers with children aged ≤10 years residing in their homes were recruited into a two-arm randomized clinical trial. Participants were assigned to one of two groups: biomarker feedback (n=98) and health education (n=97). In-home assessments were administered at baseline, week 16, and week 26. Children's home SHS exposure and nicotine, cotinine, and NNAL levels from urine samples, measured through a passive nicotine dosimeter and a surface sample of residual tobacco smoke (ie, thirdhand smoke), were collected at all three time points. Primary outcome was dosimeter-verified, self-reported complete home smoking restrictions at 6 months after randomization. Secondary outcomes included parental self-report of smoking behavior change and child urine tobacco toxin (biomarker) change. RESULTS Data collection and analyses are complete, and the results are being interpreted. CONCLUSIONS The study protocol describes the development of a novel community-based controlled trial designed to examine the efficacy of biomarker feedback documenting home and child exposure to SHS on parental smoking behavior change. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/12654.
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Affiliation(s)
- Janet Leigh Thomas
- Program in Health Disparities Research, Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Meredith Schreier
- Program in Health Disparities Research, Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Xianghua Luo
- School of Public Health, Division of Biostatistics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Sue Lowry
- Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN, United States
| | - Deborah Hennrikus
- Department of Epidemiology, University of Minnesota, Minneapolis, MN, United States
| | - Lawrence An
- Center for Health Communications Resarch, University of Michigan, Ann Arbor, MI, United States
| | - David W Wetter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Center, University of Utah, Salt Lake City, UT, United States
| | - Jasjit S Ahluwalia
- Brown University School of Public Health and Alpert School of Medicine, Providence, RI, United States
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Weiss G, Steinacher I, Lamprecht B, Kaiser B, Mikes R, Sator L, Hartl S, Wagner H, Studnicka M. Development and validation of the Salzburg COPD-screening questionnaire (SCSQ): a questionnaire development and validation study. NPJ Prim Care Respir Med 2017; 27:4. [PMID: 28127061 PMCID: PMC5434771 DOI: 10.1038/s41533-016-0005-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/30/2016] [Accepted: 10/25/2016] [Indexed: 12/21/2022] Open
Abstract
Chronic obstructive pulmonary disease prevalence rates are still high. However, the majority of subjects are not diagnosed. Strategies have to be implemented to overcome the problem of under-diagnosis. Questionnaires could be used to pre-select subjects for spirometry and thereby help reducing under-diagnosis. We report a brief, simple, self-administrable and validated chronic obstructive pulmonary disease questionnaire to increase the pre-test probability for chronic obstructive pulmonary disease diagnosis in subjects undergoing confirmatory spirometry. In 2005, we completed the Austrian Burden of Obstructive Lung Disease-study in 1258 subjects aged >40 years. Post-bronchodilator spirometry was performed, and non-reversible airflow limitation defined by FEV1/FVC ratio below the lower limit of normal. Questions from the Salzburg chronic obstructive pulmonary disease screening-questionnaire were selected using a logistic regression model, and risk scores were based on regression-coefficients. A training sub-sample (n = 800) was used to create the score, and a test sub-sample (n = 458) was used to test it. In 2008, an external validation study was done, using the same protocol in 775 patients from primary care. The Salzburg chronic obstructive pulmonary disease screening questionnaire was composed of items related to "breathing problems", "wheeze", "cough", "limitation of physical activity", and "smoking". At the >=2 points cut-off of the Salzburg chronic obstructive pulmonary disease screening questionnaire, sensitivity was 69.1% [95%CI: 56.6%; 79.5%], specificity 60.0% [95%CI: 54.9%; 64.9%], the positive predictive value 23.2% [95%CI: 17.7%; 29.7%] and the negative predictive value 91.8% [95%CI: 87.5%; 95.7%] to detect post bronchodilator airflow limitation. The external validation study in primary care confirmed these findings. The Salzburg chronic obstructive pulmonary disease screening questionnaire was derived from the highly standardized Burden of Obstructive Lung Disease study. This validated and easy to use questionnaire can help to increase the efficiency of chronic obstructive pulmonary disease case-finding. CHRONIC OBSTRUCTIVE PULMONARY DISEASE QUESTIONNAIRE FOR PRE-SCREENING POTENTIAL SUFFERERS: Scientists in Austria have developed a brief, simple questionnaire to identify patients likely to have early-stage chronic lung disease. Chronic obstructive pulmonary disease (COPD) is notoriously difficult to diagnose, and the condition often causes irreversible lung damage before it is identified. Finding a simple, cost-effective method of pre-screening patients with suspected early-stage COPD could potentially improve treatment responses and limit the burden of extensive lung function ('spirometry') tests on health services. Gertraud Weiss at Paracelsus Medical University, Austria, and co-workers have developed and validated an easy-to-use, self-administered questionnaire that could prove effective for pre-screening patients. The team trialed the five-point Salzburg COPD-screening questionnaire on 1258 patients. Patients scoring 2 points or above on the questionnaire underwent spirometry tests. The questionnaire seems to provide a sensitive and cost-effective way of pre-selecting patients for spirometry referral.
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Affiliation(s)
- Gertraud Weiss
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria.
| | - Ina Steinacher
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler-University-Hospital, Linz, Austria
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Bernhard Kaiser
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Romana Mikes
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Lea Sator
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Helga Wagner
- Department for Statistics, University of Linz, Linz, Austria
| | - M Studnicka
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
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Polonsky WH, Fisher L. When does personalized feedback make a difference? A narrative review of recent findings and their implications for promoting better diabetes self-care. Curr Diab Rep 2015; 15:50. [PMID: 26077015 DOI: 10.1007/s11892-015-0620-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Providing behavioral, biomarker, or disease risk feedback to patients is a key component of most behavioral interventions in diabetes, but it remains unclear what is necessary for such feedback to be truly engaging and effective. We sought to identify how personalized health-related feedback is most effectively designed and delivered, and how feedback may be tailored to meet the needs of individual patients with diabetes. To do so, we systematically reviewed recent findings concerning the effectiveness of feedback in eight health-related areas, including several specific to diabetes care (blood glucose monitoring and HbA1c) and others which touch on broader care dimensions (blood pressure, cholesterol, dietary intake, pedometer usage, self-weighing, and medical imaging). Five interdependent characteristics of health-related feedback were identified (clarity of the feedback message, personal meaningfulness of the feedback, frequency of feedback, guidance and support accompanying feedback, and interplay between feedback and patient characteristics) and applications for use in diabetes care were provided. Findings suggested that feedback will be most effective when it is easy for patients to understand and is personally meaningful, frequency of feedback is appropriate to the characteristics of the behavior/biomarker, guidance for using feedback is provided, and feedback is qualified by patient characteristics. We suggest that the effectiveness of feedback to promote better diabetes outcomes requires careful consideration of the feedback message, how it is delivered, and characteristics of the recipients.
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Feasibility of detection and intervention for alcohol-related liver disease in the community: the Alcohol and Liver Disease Detection study (ALDDeS). Br J Gen Pract 2014; 63:e698-705. [PMID: 24152485 DOI: 10.3399/bjgp13x673711] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In the past 15 years mortality rates from liver disease have doubled in the UK. Brief alcohol advice is cost effective, but clinically meaningful reductions in alcohol consumption only occur in around 1 in 10 individuals. AIM To provide evidence that detecting early liver disease in the community is feasible, practical, and that feedback of liver risk can increase the proportion of subjects reducing alcohol consumption. DESIGN AND SETTING A community feasibility study in nine general practice sites in Hampshire. METHOD Hazardous and harmful drinkers were identified by WHO AUDIT questionnaire and offered screening for liver fibrosis. RESULTS In total, 4630 individuals responded, of whom 1128 (24%) hazardous or harmful drinkers were offered a liver fibrosis check using the Southampton Traffic Light (STL) test; 393 (38%) attended and test results were returned by post. The STL has a low threshold for liver fibrosis with 45 (11%) red, 157 (40%) amber, and 191 (49%) green results. Follow-up AUDIT data was obtained for 303/393 (77%) and 76/153 (50%) subjects with evidence of liver damage reduced drinking by at least one AUDIT category (harmful to hazardous, or hazardous to low risk) compared with 52/150 (35%, P<0.011) subjects without this evidence; in the subset of harmful drinkers patterns (AUDIT >15), 22/34 (65%) of STL positives, reduced drinking compared with 10/29 (35%, P<0.017) STL negatives. CONCLUSION Detection of liver disease in the community is feasible, and feedback of liver risk may reduce harmful drinking.
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Oh HY, Lee HS, Lee SW, Shim KW, Chun H, Kim JY. The association of lung age with smoking status in korean men. Korean J Fam Med 2014; 35:35-41. [PMID: 24501668 PMCID: PMC3912265 DOI: 10.4082/kjfm.2014.35.1.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 12/10/2013] [Indexed: 11/27/2022] Open
Abstract
Background Lung age, calculated from sex, forced expiratory volume in one second (FEV1), and height, was developed to illustrate premature changes to the lungs and could be used to motivate smoking cessation. However, this method has not been tested in association with smoking in Korea. The purpose of this study was to investigate the association of lung age with smoking and other factors in Korean males. Methods We reviewed the records of 1,100 healthy men who visited a health promotion center at Ewha Womans University Medical Center from January 2008 to June 2009. Lung age was calculated from FEV1 and normal predictive values of spirometry according to age in the Korean population. The difference between lung age and chronological age was evaluated in relation to smoking status, weight, body mass index, waist, muscle mass, fat mass, and exercise. Results The age difference was significantly higher in current smokers than in non-smokers (12.47 ± 19.90 vs. 7.30 ± 19.52, P < 0.001). Additionally, the age difference was positively correlated with life time pack-year (β = 0.223; P < 0.001) and fat mass (β = 0.462; P < 0.001). Lung age increased 1 year for 4.48 pack-year increase or for 2.16% increase in fat mass. Conclusion We found a significant relationship between lung age and both smoking status and fat mass in healthy Korean males. Lung age may be a useful tool for motivating cessation of cigarette smoking and management of risk factors related to obesity.
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Affiliation(s)
- Hye Young Oh
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hong Soo Lee
- Department of Family Medicine, Ewha Womans University Medical Center, Seoul, Korea
| | - Sang Wha Lee
- Department of Family Medicine, Ewha Womans University Medical Center, Seoul, Korea
| | - Kyung Won Shim
- Department of Family Medicine, Ewha Womans University Medical Center, Seoul, Korea
| | - Hyejin Chun
- Department of Family Medicine, Ewha Womans University Medical Center, Seoul, Korea
| | - Joo Yeon Kim
- Department of Family Medicine, Seoul Medical Center, Seoul, Korea
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Chen CC, Chang CH, Tsai YC, Tseng CW, Tu ML, Wang CC, Lin MC, Liu SF. Utilizing exhaled carbon monoxide measurement with self-declared smoking cessation: enhancing abstinence effectiveness in Taiwanese outpatients. CLINICAL RESPIRATORY JOURNAL 2014; 9:7-13. [PMID: 24345098 DOI: 10.1111/crj.12096] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 11/12/2013] [Accepted: 12/13/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Presently, the Department of Health Taiwan has begun to fund a smoking cessation program, and the annual cessation rate was 8.9% in 2010. This study aims to see whether to enhance abstinence effectiveness by utilizing exhaled carbon monoxide (COExh) measurement with self-declared smoking cessation. METHODS The longitudinal prospective study gathered 33 subjects on quitting smoking with the motivation to join the grant program in chest outpatient from August 2009 to July 2010. Overall, subjects were given nicotine replacement therapy (NRT) in the first stage, and explored abstinence rate results in evaluation stage. The cutoff point of COExh 6 ppm or less than (≤) and patients' self-declared abstinence reports confirmed a smoking cessation success status. Point abstinences were defined as the smokers refrained from smoking at least 7 days, while continuous abstinences were defined as nonsmoking at least 3, 6 and 12 months. RESULTS The validities were 198 tracking results for two stages (P < 0.001 vs P < 0.001), and sensitivity (56.5% vs 60.0%), specificity (90.1% vs 82.6%), positive predictive value (63.4% vs 60.0%) and negative predictive value (87.2% vs 82.6%) were detected. Moreover, the validities were 33 results for point and continuous abstinences at 3 month (P < 0.001 vs P < 0.001), and higher successful rates. Point abstinence rates at 3, 6 and 12 months follow-up for overall subjects were 27.2%, 15.2% and 18.1%, respectively. Continuous abstinence rates at 3, 6 and 12 months were 24.2%, 12.1% and 12.1%, respectively. CONCLUSIONS Utilizing COExh measurement with self-declared smoking cessation enhanced abstinence effectiveness in Taiwanese outpatients.
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Affiliation(s)
- Chiung-Chu Chen
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Irizar-Aramburu MI, Martínez-Eizaguirre JM, Pacheco-Bravo P, Diaz-Atienza M, Aguirre-Arratibel I, Peña-Peña MI, Alba-Latorre M, Galparsoro-Goikoetxea M. Effectiveness of spirometry as a motivational tool for smoking cessation: a clinical trial, the ESPIMOAT study. BMC FAMILY PRACTICE 2013; 14:185. [PMID: 24308728 PMCID: PMC4028857 DOI: 10.1186/1471-2296-14-185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/26/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Smoking is the main preventable cause of morbidity and mortality in our region, it being the main causative agent of chronic obstructive pulmonary disease. There still is no consensus on the use of spirometry as a strategy for smoking cessation, given that there is insufficient scientific evidence from high quality studies to recommend the use of this technique. METHODS/DESIGN This is to be a randomized, multicentre, open-label clinical trial. A total of 444 smokers over 40 years of age will be recruited by 39 general practitioners from 22 health centers. Primary objective of this study is to assess the effectiveness of spirometry together with information regarding the test for smoking cessation after 1 year in smokers over 40 years of age with a more than 10 pack-year history and no previous diagnosis of chronic obstructive pulmonary disease. Groups of 45 patients who smoke will be randomly selected from the lists of the participating doctors. The names will be sent to the corresponding doctors who will contact candidate patients and assess whether they meet the selection criteria. Patients who meet these criteria will be randomly allocated to an intervention or control group. For patients in both groups, a nurse will conduct an interview and perform a spirometry test to measure forced vital capacity. Then, all patients will be referred for an appointment with their doctor for brief anti-smoking intervention, patients from the intervention group additionally being informed about the result of the spirometry test. After 1 year, smoking status will be assessed and, in those who report that they have quit smoking, abstinence will be confirmed by co-oximetry. Data will be analyzed on an intention-to-treat basis using the chi-squared test for outcomes and binary logistic regression if it is considered to be necessary to adjust for confounding variables. DISCUSSION Performing a spirometry test and providing information on pulmonary function may increase awareness of the effect of smoking among smokers who are asymptomatic or have few symptoms and make them decide to quit. Specifically, in patients with chronic obstructive pulmonary disease it might increase levels of motivation to quit smoking in early stages of the disease. If this strategy were to be effective, it could be included in the health promotion activities offered in primary care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01821885.
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Ripoll J, Girauta H, Ramos M, Medina-Bombardó D, Pastor A, Alvarez-Ossorio C, Gorreto L, Esteva M, García E, Uréndez A, Buades A, Torres E. Clinical trial on the efficacy of exhaled carbon monoxide measurement in smoking cessation in primary health care. BMC Public Health 2012; 12:322. [PMID: 22551017 PMCID: PMC3390274 DOI: 10.1186/1471-2458-12-322] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 05/02/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Smoking cessation is beneficial for our health at any point in life, both in healthy people and in people already suffering from a smoking-related disease. Any help to quit smoking can produce considerable benefits for Public Health. The purpose of the present study is to evaluate the efficacy of the CO-oximetry technique together with brief advice in smoking cessation, in terms of reduction of the number of cigarettes or in the variation of the motivation to quit smoking at month 12 compared with brief advice alone. METHODS/DESIGN Randomised, parallel, single-blind clinical trial in a primary health care setting in Majorca (Spain). Smokers in contemplation or pre-contemplation phase will be included in the study. EXCLUSION CRITERIA Smokers in preparation phase, subjects with a terminal illness or whose health status does not allow them to understand the study or complete the informed consent, and pregnant or breastfeeding women. The subjects will be randomly assigned to the control group (CG) or the intervention group (IG). The CG will receive brief advice, and the IG will receive brief advice together with a measurement of exhaled CO. There will be follow-up evaluations at 6 and 12 months after inclusion. 471 subjects will be needed per group in order to detect a difference between groups ≥ 5%. PRIMARY OUTCOME sustained smoking cessation (at 6 and 12 months) confirmed by urine cotinine test. SECONDARY OUTCOMES point smoking cessation at 6 and 12 months both confirmed by urine cotinine analysis and self-reported, reduction in cigarette consumption, and variation in phase of smoking cessation. DISCUSSION CO-oximetry is an inexpensive, non-invasive, fast technique that requires little technical training; making it a technique for risk assessment in smokers that can be easily applied in primary care and, if proven effective, could serve as a reinforcement aid in smoking cessation intervention activities. TRIAL REGISTRATION Current Controlled Trials ISRCTN67499921.
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Affiliation(s)
- Joana Ripoll
- Primary Care Research Unit of Mallorca, Baleares Health services-IbSalut, Mallorca, Spain
| | - Helena Girauta
- Primary Care Research Unit of Mallorca, Baleares Health services-IbSalut, Mallorca, Spain
| | - Maria Ramos
- Public Health Department, Balearic Islands Health Department, Mallorca, Spain
| | | | - Agnès Pastor
- Sineu Health Care Centre, Baleares Health services-IbSalut, Mallorca, Spain
| | | | - Lucía Gorreto
- Emili Darder Health Care Centre, Baleares Health services-IbSalut, Mallorca, Spain
| | - Maria Esteva
- Artà Health Care Centre, Baleares Health services-IbSalut, Mallorca, Spain
| | - Elena García
- Sant Agustí Health Care Centre, Baleares Health services-IbSalut, Mallorca, Spain
| | - Ana Uréndez
- Son Pisà Health Care Centre, Baleares Health services-IbSalut, Mallorca, Spain
| | - Ana Buades
- Primary Care Research Unit of Mallorca, Baleares Health services-IbSalut, Mallorca, Spain
| | - Elena Torres
- Primary Care Research Unit of Mallorca, Baleares Health services-IbSalut, Mallorca, Spain
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Jepson RG, Harris FM, Platt S, Tannahill C. The effectiveness of interventions to change six health behaviours: a review of reviews. BMC Public Health 2010; 10:538. [PMID: 20825660 PMCID: PMC2944371 DOI: 10.1186/1471-2458-10-538] [Citation(s) in RCA: 214] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 09/08/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Several World Health Organisation reports over recent years have highlighted the high incidence of chronic diseases such as diabetes, coronary heart disease and cancer. Contributory factors include unhealthy diets, alcohol and tobacco use and sedentary lifestyles. This paper reports the findings of a review of reviews of behavioural change interventions to reduce unhealthy behaviours or promote healthy behaviours. We included six different health-related behaviours in the review: healthy eating, physical exercise, smoking, alcohol misuse, sexual risk taking (in young people) and illicit drug use. We excluded reviews which focussed on pharmacological treatments or those which required intensive treatments (e.g. for drug or alcohol dependency). METHODS The Cochrane Library, Database of Abstracts of Reviews of Effectiveness (DARE) and several Ovid databases were searched for systematic reviews of interventions for the six behaviours (updated search 2008). Two reviewers applied the inclusion criteria, extracted data and assessed the quality of the reviews. The results were discussed in a narrative synthesis. RESULTS We included 103 reviews published between 1995 and 2008. The focus of interventions varied, but those targeting specific individuals were generally designed to change an existing behaviour (e.g. cigarette smoking, alcohol misuse), whilst those aimed at the general population or groups such as school children were designed to promote positive behaviours (e.g. healthy eating). Almost 50% (n = 48) of the reviews focussed on smoking (either prevention or cessation). Interventions that were most effective across a range of health behaviours included physician advice or individual counselling, and workplace- and school-based activities. Mass media campaigns and legislative interventions also showed small to moderate effects in changing health behaviours.Generally, the evidence related to short-term effects rather than sustained/longer-term impact and there was a relative lack of evidence on how best to address inequalities. CONCLUSIONS Despite limitations of the review of reviews approach, it is encouraging that there are interventions that are effective in achieving behavioural change. Further emphasis in both primary studies and secondary analysis (e.g. systematic reviews) should be placed on assessing the differential effectiveness of interventions across different population subgroups to ensure that health inequalities are addressed.
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Affiliation(s)
- Ruth G Jepson
- Department of Nursing and Midwifery, University of Stirling, Stirling, FK9 4LA, UK
| | - Fiona M Harris
- Nursing Midwifery & Allied Health ProfessionsResearch Unit, University of Stirling, Stirling, UK
| | - Stephen Platt
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, EH8 9AG, UK
| | - Carol Tannahill
- Glasgow Centre for Population Health, 94 Elmbank Street, Glasgow, G2 4DL, UK
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Sejourne C, Parot-Schinckel E, Rouquette A, Pare F, Delcroix M, Fanello S. [Impact of exhaled CO measurement. A randomised study among 578 smoking patients in general practice]. Rev Mal Respir 2010; 27:213-8. [PMID: 20359612 DOI: 10.1016/j.rmr.2010.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 08/24/2009] [Indexed: 11/17/2022]
Abstract
UNLABELLED Nicotine addiction (NA) is a serious public health problem and helping patients to stop consumption is a major concern for general practitioners (GP). The positive effects of "brief advice" are well known. The aim of our paper is to evaluate the effectiveness of adding exhaled carbon monoxide (CO) measurement using a CO analyser to a normal smoking cessation practice in a GP's office. METHODS This was a descriptive study, using a questionnaire, among randomised smoking patients; one group receiving brief advice and the other brief advice plus exhaled CO analysis in their GP's office. RESULTS Five hundred and seventy-eight questionnaires were analysed: 60% of smoking patients wished to stop smoking and 72% within the next 6 months, without significant difference between the two groups. In the group "minimal advice plus CO analyser" (282), 60% of the smokers reported that they had been influenced by the results of the level of CO in the exhaled air and were more motivated to quit because of this. CONCLUSION Measuring the level of exhaled CO in smokers helps to inform them of the dangers of their addiction and helps to motivate them to quit.
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Affiliation(s)
- C Sejourne
- Département universitaire de santé publique, CHU d'Angers, 49933 Angers cedex 9, France
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Molina AJ, Fernández D, Delgado M, Martín V. Sensitivity and specificity of a self-administered questionnaire of tobacco use; including the Fagerström test. Int J Nurs Stud 2010; 47:181-9. [DOI: 10.1016/j.ijnurstu.2009.05.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 05/26/2009] [Accepted: 05/31/2009] [Indexed: 11/24/2022]
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Hollands GJ, Hankins M, Marteau TM. Visual feedback of individuals' medical imaging results for changing health behaviour. Cochrane Database Syst Rev 2010:CD007434. [PMID: 20091633 DOI: 10.1002/14651858.cd007434.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Feedback of medical imaging results can reveal visual evidence of actual bodily harm attributable to a given behaviour. This may offer a particularly promising approach to motivating changes in health behaviour to decrease risk. Applicable behaviours include smoking cessation, skin self-examination, sun protection behaviour, dietary intake, physical activity and medication usage. The current review assembles and evaluates the evidence concerning the behavioural impact of showing and explaining images, in order to determine whether their communication is an effective intervention approach. OBJECTIVES To assess the extent to which feedback to individuals of images of their own bodies created during medical imaging procedures increases or decreases a range of health behaviours. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3 2009), MEDLINE (1950 to 14 September 2009), EMBASE (1980 to 14 September 2009), CINAHL (1982 to 9 October 2009), PsycINFO (1806 to 14 September 2009) and reference lists of articles. We also contacted authors of selected papers, and searched the ProQuest Dissertations and Theses database on 1 October 2009 for grey literature. SELECTION CRITERIA Randomised or quasi-randomised controlled trials involving adult (18 years and over) non-pregnant individuals undergoing medical imaging procedures assessing risk of disease or of an existing condition, for which personal risk may be reduced by modification of behaviour. The sole or principal component of included interventions is visual feedback of individuals' medical imaging results, defined as individuals being shown, and having explained, source images (still or moving images) of their bodies generated by the procedure. DATA COLLECTION AND ANALYSIS Two authors searched for studies and independently extracted data from included studies, with disagreements resolved by consensus and a third author acting as arbiter. The risk of bias of included studies was assessed and reported in accordance with the guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. We conducted a narrative synthesis of the included studies, dividing them into clinical and non-clinical population groups and presenting major characteristics and results. Where the studies were sufficiently similar in terms of population, inclusion criteria, interventions and/or outcomes, we pooled the data statistically. MAIN RESULTS We included nine trials involving 1371 participants. Overall, results were mixed. Regarding five trials in clinical populations, three assessed smoking cessation behaviours, all featuring arterial scanning procedures to assess cardiovascular risk, and reported a statistically significant effect favouring the intervention, producing a pooled odds ratio (OR) of 2.81 (95% confidence interval (CI) 1.23 to 6.41, P = 0.01). One of these trials also measured physical activity and reported no statistically significant difference between the groups. A further trial measured skin examination behaviour following a skin photography procedure for assessing moles, and reported a statistically significant increase in favour of the intervention, with an OR of 4.86 (95% CI 1.95 to 12.10, P = 0.0007). The final clinical population trial measured a range of dietary intake and medication usage behaviours and featured an arterial scanning procedure assessing cardiovascular risk, and reported no statistically significant effects.Among the four trials in non-clinical populations, all featuring ultraviolet (UV) photography to highlight UV-related skin damage, a statistically significant result favouring the intervention was found in one trial for reducing tanning booth use, producing a mean difference (MD) of -1.10 (95% CI -1.90 to -0.30, P = .007) and one trial reported an outcome on which the control condition was favoured, with an MD of 0.45 (95% CI 0.04 to 0.86, P = 0.03) on intentional hours spent in the sun. In two further trials, no statistically significant behavioral effects were reported regarding time spent in the sun or sun protection behaviours.There was no evidence of significant adverse effects in the included trials, although this was not well reported. AUTHORS' CONCLUSIONS Due to the limited nature of the available evidence and the mixed results that were found, no strong statements can be made about the effectiveness of communicating medical imaging results to change health behaviour. Only three trials in clinical populations were similar enough in term of setting, intervention and outcome to allow meta-analysis. We suggest, however, that targeted interventions using medical imaging technologies may be effective in certain contexts, or as applied to certain behaviours, but that this should be considered on an intervention by intervention basis, and not assumed as a general principle.
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Affiliation(s)
- Gareth J Hollands
- Health Psychology Section, King's College London, 5th Floor, Bermondsey Wing, Guy's Campus, London, UK, SE1 9RT
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Anderson CM, Yip R, Henschke CI, Yankelevitz DF, Ostroff JS, Burns DM. Smoking Cessation and Relapse during a Lung Cancer Screening Program. Cancer Epidemiol Biomarkers Prev 2009; 18:3476-83. [DOI: 10.1158/1055-9965.epi-09-0176] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Stotts AL, Groff JY, Velasquez MM, Benjamin-Garner R, Green C, Carbonari JP, DiClemente CC. Ultrasound feedback and motivational interviewing targeting smoking cessation in the second and third trimesters of pregnancy. Nicotine Tob Res 2009; 11:961-8. [PMID: 19553282 PMCID: PMC2711985 DOI: 10.1093/ntr/ntp095] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 03/05/2009] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Cigarette smoking during pregnancy is associated with poor maternal and child health outcomes. Effective interventions to increase smoking cessation rates are needed particularly for pregnant women unable to quit in their first trimester. Real-time ultrasound feedback focused on potential effects of smoking on the fetus may be an effective treatment adjunct, improving smoking outcomes. METHODS A prospective randomized trial was conducted to evaluate the efficacy of a smoking cessation intervention consisting of personalized feedback during ultrasound plus motivational interviewing-based counseling sessions. Pregnant smokers (N = 360) between 16 and 26 weeks of gestation were randomly assigned to one of three groups: Best Practice (BP) only, Best Practice plus ultrasound feedback (BP+US), or Motivational Interviewing-based counseling plus ultrasound feedback (MI+US). Assessments were conducted at baseline and end of pregnancy (EOP). RESULTS Analyses of cotinine-verified self-reported smoking status at EOP indicated that 10.8% of the BP group was not smoking at EOP; 14.2% in the BP+US condition and 18.3% who received MI+US were abstinent, but differences were not statistically significant. Intervention effects were found conditional upon level of baseline smoking, however. Nearly 34% of light smokers (< or =10 cigarettes/day) in the MI+US condition were abstinent at EOP, followed by 25.8% and 15.6% in the BP+US and BP conditions, respectively. Heavy smokers (>10 cigarettes/day) were notably unaffected by the intervention. DISCUSSION Future research should confirm benefit of motivational interviewing plus ultrasound feedback for pregnant light smokers and explore mechanisms of action. Innovative interventions for pregnant women smoking at high levels are sorely needed.
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Affiliation(s)
- Angela L Stotts
- Department of Family and Community Medicine, University of Texas Medical School at Houston, 6431 Fannin, JJL 324, Houston, TX 77030, USA.
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McClure JB, Ludman EJ, Grothaus L, Pabiniak C, Richards J. Impact of a brief motivational smoking cessation intervention the Get PHIT randomized controlled trial. Am J Prev Med 2009; 37:116-23. [PMID: 19524389 PMCID: PMC2889910 DOI: 10.1016/j.amepre.2009.03.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 03/09/2009] [Accepted: 03/25/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND Few studies have rigorously evaluated whether providing biologically based health-risk feedback is more effective than standard interventions in increasing smokers' motivation to quit and their long-term abstinence. DESIGN An RCT was conducted from 2005 to 2008. Data were analyzed in 2008. SETTING/PARTICIPANTS Smokers (N=536) were recruited from the community, regardless of their interest in quitting smoking. INTERVENTION Smokers either received brief ( approximately 20 minutes), personally tailored counseling sessions based on their lung functioning, carbon monoxide (CO) exposure, and smoking-related health conditions, or they received generic smoking-risk information and personalized counseling about their diet, BMI, and physical activity. All were advised to quit smoking and were offered access to a free phone-counseling program. MAIN OUTCOME MEASURES Treatment utilization and abstinence at 6 and 12 months post-intervention. RESULTS Participants who received the experimental treatment demonstrated no greater motivation to quit, use of treatment services, or abstinence compared to controls at either follow-up assessment. In fact, controls reported greater motivation to quit at 12 months (M 3.42 vs 3.20, p=0.03), greater use of pharmacotherapy at 6 months (37.8% vs 28.0%, p=0.02), and greater 30-day point prevalent abstinence at 6 months, after controlling for relevant covariates (10.8% vs 6.4%, adjusted p=0.04). CONCLUSIONS The present study found no support for adding a personalized health-risk assessment emphasizing lung health and CO exposure to generic cessation advice and counseling for community-based smokers not otherwise seeking treatment. TRIAL REGISTRATION NCT00169260.
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Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev 2009:CD001055. [PMID: 19588322 PMCID: PMC4090746 DOI: 10.1002/14651858.cd001055.pub3] [Citation(s) in RCA: 353] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, low birthweight, preterm birth and has serious long-term health implications for women and babies. Smoking in pregnancy is decreasing in high-income countries and increasing in low- to middle-income countries and is strongly associated with poverty, low educational attainment, poor social support and psychological illness. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2008), the Cochrane Tobacco Addiction Group's Trials Register (June 2008), EMBASE, PsycLIT, and CINAHL (all from January 2003 to June 2008). We contacted trial authors to locate additional unpublished data. SELECTION CRITERIA Randomised controlled trials where smoking cessation during pregnancy was a primary aim of the intervention. DATA COLLECTION AND ANALYSIS Trials were identified and data extracted by one person and checked by a second. Subgroup analysis was conducted to assess the effect of risk of trial bias, intensity of the intervention and main intervention strategy used. MAIN RESULTS Seventy-two trials are included. Fifty-six randomised controlled trials (over 20,000 pregnant women) and nine cluster-randomised trials (over 5000 pregnant women) provided data on smoking cessation outcomes.There was a significant reduction in smoking in late pregnancy following interventions (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.93 to 0.96), an absolute difference of six in 100 women who stopped smoking during pregnancy. However, there is significant heterogeneity in the combined data (I(2) > 60%). In the trials with the lowest risk of bias, the interventions had less effect (RR 0.97, 95% CI 0.94 to 0.99), and lower heterogeneity (I(2) = 36%). Eight trials of smoking relapse prevention (over 1000 women) showed no statistically significant reduction in relapse.Smoking cessation interventions reduced low birthweight (RR 0.83, 95% CI 0.73 to 0.95) and preterm birth (RR 0.86, 95% CI 0.74 to 0.98), and there was a 53.91g (95% CI 10.44 g to 95.38 g) increase in mean birthweight. There were no statistically significant differences in neonatal intensive care unit admissions, very low birthweight, stillbirths, perinatal or neonatal mortality but these analyses had very limited power. AUTHORS' CONCLUSIONS Smoking cessation interventions in pregnancy reduce the proportion of women who continue to smoke in late pregnancy, and reduce low birthweight and preterm birth. Smoking cessation interventions in pregnancy need to be implemented in all maternity care settings. Given the difficulty many pregnant women addicted to tobacco have quitting during pregnancy, population-based measures to reduce smoking and social inequalities should be supported.
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Affiliation(s)
- Judith Lumley
- Mother and Child Health Research, La Trobe University, Melbourne, Australia
| | - Catherine Chamberlain
- 3Centres Collaboration, Women and Children’s Program, Southern Health, Clayton South, Australia
| | - Therese Dowswell
- Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, The University of Liverpool, Liverpool, UK
| | - Sandy Oliver
- Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Laura Oakley
- Non-communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - Lyndsey Watson
- Mother and Child Health Research, La Trobe University, Melbourne, Australia
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Kotz D, Huibers MJH, West RJ, Wesseling G, van Schayck OCP. What mediates the effect of confrontational counselling on smoking cessation in smokers with COPD? PATIENT EDUCATION AND COUNSELING 2009; 76:16-24. [PMID: 19150590 DOI: 10.1016/j.pec.2008.11.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 11/07/2008] [Accepted: 11/29/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Within the framework of a randomized, active treatment controlled trial, we used a mediation analysis to understand the mechanisms by which an intervention that uses confrontation with spirometry for smoking cessation achieves its effects. METHODS Participants were 228 smokers from the general population with previously undetected chronic obstructive pulmonary disease (COPD), who were detected with airflow limitation by means of spirometry. They received two equally intensive behavioural treatments by a respiratory nurse combined with nortriptyline for smoking cessation: confrontational counselling with spirometry versus conventional health education and promotion (excluding confrontation with spirometry and COPD). RESULTS Cotinine validated abstinence rates from smoking at 5 weeks after the target quit date were 43.1% in the confrontational counselling group versus 31.3% in the control group (OR=1.67, 95%CI=0.97-2.87). The effect of confrontational counselling on abstinence was independently mediated by the expectation of getting a serious smoking related disease in the future (OR=1.76, 95%CI=1.03-3.00), self-exempting beliefs (OR=0.42, 95%CI=0.21-0.84), and self-efficacy (OR=1.38, 95%CI=1.11-1.73). CONCLUSION We conclude that confrontational counselling increases risk perceptions and self-efficacy, and decreases self-exempting beliefs (risk denial) in smokers with previously undetected COPD. These changes in mediators are associated with a higher likelihood of smoking cessation. PRACTICE IMPLICATIONS Apart from the intensity, the content of smoking cessation counselling may be an important factor of success. A confrontational counselling approach as we applied may have the potential to alter smoking-related cognitions in such a way that smokers are more successful in quitting. Nurses can be trained to deliver this treatment.
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Affiliation(s)
- Daniel Kotz
- Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands.
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Cost-effectiveness of a smoking cessation program implemented at the time of surgery for lung cancer. J Thorac Oncol 2009; 4:499-504. [PMID: 19204575 DOI: 10.1097/jto.0b013e318195e23a] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many patients are active smokers at the time of a diagnosis of surgically resectable lung cancer. Perioperative smoking cessation is associated with improved survival, but the cost-effectiveness of a smoking cessation program initiated immediately before surgery is unknown. METHODS We developed a decision analytic Markov model to evaluate the incremental cost-effectiveness of a formal smoking cessation program. The parameter estimates were taken from the available literature. The model included the cost and effectiveness of the smoking cessation program, cost and incidence of perioperative complications, postoperative mortality, and utility measured in quality adjusted life years (QALY). Dollars per QALY and life year were calculated and one-way sensitivity analyses were performed. RESULTS The cost/QALY and cost/life year were $16,415 and $45,629 at 1 year after surgery and $2609 and $2703 at 5 years, respectively. Most sensitivity analyses showed the 1 year postsurgery cost/QALY estimates were less than $50,000, and all were less than $12,000 at 5 years. Cost-effectiveness estimates were most sensitive to the frequency of perioperative complications and the estimated short-term utility estimates. CONCLUSION A smoking cessation program initiated before surgical lung resection is cost-effective at both 1 and 5 years postsurgery. Providers should encourage patients who are still smoking to engage in formal smoking cessation programs.
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Andreas S, Hering T, Mühlig S, Nowak D, Raupach T, Worth H. Smoking cessation in chronic obstructive pulmonary disease: an effective medical intervention. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:276-82. [PMID: 19547629 DOI: 10.3238/arztebl.2009.0276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 02/18/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND As many as 50% of older smokers develop chronic obstructive pulmonary disease (COPD), and more than 80% of COPD-associated morbidity is caused by tobacco smoking. Despite the severe symptoms from which COPD patients suffer, they are often unable to quit smoking on their own. METHODS Experts from 9 medical societies, under the aegis of the German Society of Pulmonology and Respiratory Medicine (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin), have developed an S3 guideline on smoking cessation in COPD. They took previously published guidelines into account, as well as more than 2000 initially surveyed publications, and created the new guideline in two consensus conferences followed by a Delphi process. RESULTS The following strongly evidence-based statements can be made: A smoking cessation strategy based on a combination of medication and psychosocial support has been found to be effective in COPD patients. Smoking cessation improves pulmonary function, alleviates dyspnea and cough, reduces the frequency of COPD exacerbations, and lowers mortality. Mere smoking reduction does not improve pulmonary function or alleviate symptoms. Smoking cessation is the most effective and least expensive single means of lowering the risk of developing COPD and of arresting its progression. Smoking cessation should therefore be strongly promoted at all levels of health care delivery. CONCLUSIONS There is no question that smoking cessation ranks among the most effective medical interventions, yet the German health care system still does not assign it an adequate priority.
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Affiliation(s)
- Stefan Andreas
- Lungenfachklinik Immenhausen/Kreis Kassel Pneumologische Lehrklinik der Universität Göttingen Robert Koch Str. 3 34376 Immenhausen, Germany.
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Abstract
BACKGROUND Healthcare professionals frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti-smoking advice on disease-specific and all-cause mortality. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group trials register. Date of the most recent search: September 2007. SELECTION CRITERIA Randomized trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided. DATA COLLECTION AND ANALYSIS We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomization and completeness of follow up. The main outcome measure was abstinence from smoking after at least six months follow up. We also considered the effect of advice on mortality where long-term follow-up data were available. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow up were counted as smokers. Effects were expressed as relative risks. Where possible, meta-analysis was performed using a Mantel-Haenszel fixed effect model. MAIN RESULTS We identified 41 trials, conducted between 1972 and 2007, including over 31,000 smokers. In some trials, subjects were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics. Pooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (relative risk (RR) 1.66, 95% confidence interval (CI) 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow-up visits. Only one study determined the effect of smoking advice on mortality. This study found no statistically significant differences in death rates at 20 years follow up. AUTHORS' CONCLUSIONS Simple advice has a small effect on cessation rates. Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%. Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions.
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Affiliation(s)
- L F Stead
- University of Oxford, Department of Primary Health Care, Old Road Campus, Headington, Oxford, UK OX3 7LF.
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Abstract
Spirometry with pictorial feedback on lung age, not just raw data, improves quit rates
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Parkes G, Greenhalgh T, Griffin M, Dent R. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ 2008; 336:598-600. [PMID: 18326503 PMCID: PMC2267989 DOI: 10.1136/bmj.39503.582396.25] [Citation(s) in RCA: 246] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the impact of telling patients their estimated spirometric lung age as an incentive to quit smoking. DESIGN Randomised controlled trial. SETTING Five general practices in Hertfordshire, England. PARTICIPANTS 561 current smokers aged over 35. INTERVENTION All participants were offered spirometric assessment of lung function. Participants in intervention group received their results in terms of "lung age" (the age of the average healthy individual who would perform similar to them on spirometry). Those in the control group received a raw figure for forced expiratory volume at one second (FEV1). Both groups were advised to quit and offered referral to local NHS smoking cessation services. MAIN OUTCOME MEASURES The primary outcome measure was verified cessation of smoking by salivary cotinine testing 12 months after recruitment. Secondary outcomes were reported changes in daily consumption of cigarettes and identification of new diagnoses of chronic obstructive lung disease. RESULTS Follow-up was 89%. Independently verified quit rates at 12 months in the intervention and control groups, respectively, were 13.6% and 6.4% (difference 7.2%, P=0.005, 95% confidence interval 2.2% to 12.1%; number needed to treat 14). People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group. Cost per successful quitter was estimated at 280 pounds sterling (366 euros, $556). A new diagnosis of obstructive lung disease was made in 17% in the intervention group and 14% in the control group; a total of 16% (89/561) of participants. CONCLUSION Telling smokers their lung age significantly improves the likelihood of them quitting smoking, but the mechanism by which this intervention achieves its effect is unclear. TRIAL REGISTRATION National Research Register N0096173751.
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Affiliation(s)
- Gary Parkes
- The Limes Surgery, Hoddesdon, Hertfordshire EN11 8EP.
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Bize R, Burnand B, Mueller Y, Cornuz J. Effectiveness of biomedical risk assessment as an aid for smoking cessation: a systematic review. Tob Control 2007; 16:151-6. [PMID: 17565124 PMCID: PMC2598501 DOI: 10.1136/tc.2006.017731] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the efficacy of biomedical risk assessment (eg, exhaled carbon monoxide (CO), or genetic susceptibility to lung cancer) as an aid for smoking cessation. DATA SOURCES Cochrane Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials, Medline (1966-2004) and EMBASE (1980-2004). STUDY SELECTION Randomised controlled smoking cessation interventions using biomedical tests with at least 6 months follow-up. DATA EXTRACTION Two reviewers independently screened all search results (titles and abstracts) for possible inclusion. Each reviewer then extracted data from the selected studies, and assessed their methodological quality based on the CONSORT (Consolidated Standards of Reporting Trials) statement criteria. DATA SYNTHESIS Of 4049 retrieved references, eight trials were retained for data extraction and analysis. Three trials isolated the effect of exhaled CO on smoking cessation rates resulting in the following ORs and 95% CIs: 0.73 (0.38 to 1.39), 0.93 (0.62 to 1.41) and 1.18 (0.84 to 1.64). Measurement of exhaled CO and spirometry were used together in three trials, resulting in the following ORs (95% CI): 0.60 (0.25 to 1.46), 2.45 (0.73 to 8.25) and 3.50 (0.88 to 13.92). Spirometry results alone were used in one other trial with an OR (95% CI) of 1.21 (0.60 to 2.42). Ultrasonography of carotid and femoral arteries performed on light smokers gave an OR (95% CI) of 3.15 (1.06 to 9.31). CONCLUSIONS Scarcity and limited quality of the current evidence does not support the hypothesis that biomedical risk assessment increases smoking cessation as compared with the standard treatment.
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Affiliation(s)
- Raphaël Bize
- Department of Ambulatory Care and Community Medicine, University of Lausanne, 44 Rue du Bugnon, CH-1011 Lausanne, Switzerland.
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Verbanck S, Schuermans D, Paiva M, Meysman M, Vincken W. Small Airway Function Improvement after Smoking Cessation in Smokers without Airway Obstruction. Am J Respir Crit Care Med 2006; 174:853-7. [PMID: 16799076 DOI: 10.1164/rccm.200603-422oc] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Studying smokers with normal spirometry requires monitoring tools of the peripheral lung. A validated multiple breath washout technique was used to assess possible recovery of smoking-induced small airway malfunction in acinar and conductive lung zones. METHODS Eighty-seven smokers with a smoking history of at least 10 pack-years but absence of spirometric airflow obstruction were invited for assessment of lung function and small airway function at baseline and after 1 wk, 3 mo, 6 mo, and 12 mo of smoking cessation. A control group of 16 persistent smokers was studied at the same time intervals. MEASUREMENTS AND MAIN RESULTS Of the 87 smokers, 66, 32, 28, and 21% successfully ceased smoking for 1 wk, 3 mo, 6 mo, and 12 mo, respectively. Lung function parameters remained essentially unaffected by smoking cessation. Ventilation heterogeneity showed transient improvements after 1 wk in the acinar lung compartment with a return to baseline afterwards. By contrast, there were persistent improvements in the conductive airway compartment; for example, smokers who successfully quit smoking for 12 mo (n=18) showed a 30 and 42% reduction of conductive airways abnormality after 1 wk and 1 yr, respectively. CONCLUSIONS Smokers with early signs of small airway malfunction who successfully quit smoking show sustained improvements of conductive airway malfunction. In contrast, acinar airway malfunction quickly returns to baseline after a transient improvement.
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Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, Academic Hospital, Vrije Universiteit Brussel, Brussels, Belgium.
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