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Mauduy M, Mauny N, Mange J. Tobacco Dependence Among French University Students: A Cluster Analytic Approach to Identifying Distinct Psychological Profiles of Smokers. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221107560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigates the combination of several psychological factors related to tobacco smoking to identify smokers’ psychological profiles among French university students. A cluster analysis was performed on smoking motives, psychosocial variables, and the smoker identity ( N = 909). Five profiles were identified and then compared regarding tobacco dependence and motivations to quit. “Normative” and “sociohedonist smokers” are characterized by two distinct social factors (normative influences and social motives) and moderate dependence. “Dependent identified smokers” have higher levels of dependence motives, smoker identity and tobacco dependence associated with low motivations to quit. “Inconsistent smokers” have weak smoker identity and weak smoking motives, a strong perceived control over resisting smoking, low dependence and motivations to quit. “Coping smokers” have strong sedative and addictive motives and exhibit moderate dependence and motivations to quit. This research encourages prevention programs to consider the diversity of student smokers with strategies adapted to their psychological profiles.
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Affiliation(s)
- Maxime Mauduy
- Psychology, LPCN, University of Caen Normandy, Caen, France
| | - Nicolas Mauny
- Psychology, LPCN, University of Caen Normandy, Caen, France
| | - Jessica Mange
- Psychology, LPCN, University of Caen Normandy, Caen, France
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Gupta S, Panchal P, Sadatsafavi M, Ghanouni P, Sin D, Pakhale S, To T, Zafari Z, Nimmon L. A personalized biomedical risk assessment infographic for people who smoke with COPD: a qualitative study. Addict Sci Clin Pract 2022; 17:1. [PMID: 34991699 PMCID: PMC8734321 DOI: 10.1186/s13722-021-00283-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/03/2021] [Indexed: 01/24/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) causes 3 million deaths each year, yet 38% of COPD patients continue to smoke. Despite proof of effectiveness and universal guideline recommendations, smoking cessation interventions are underused in practice. We sought to develop an infographic featuring personalized biomedical risk assessment through future lung function decline prediction (with vs without ongoing smoking) to both prompt and enhance clinician delivery of smoking cessation advice and pharmacotherapy, and augment patient motivation to quit. Methods We recruited patients with COPD and pulmonologists from a quaternary care center in Toronto, Canada. Infographic prototype content and design was based on best evidence. After face validation, the prototype was optimized through rapid-cycle design. Each cycle consisted of: (1) infographic testing in a moderated focus group and a clinician interview (recorded/transcribed) (with questionnaire completion); (2) review of transcripts for emergent/critical findings; and (3) infographic modifications to address findings (until no new critical findings emerged). We performed iterative transcript analysis after each cycle and a summative qualitative transcript analysis with quantitative (descriptive) questionnaire analysis. Results Stopping criteria were met after 4 cycles, involving 20 patients (58% male) and 4 pulmonologists (50% male). The following qualitative themes emerged: Tool content (infographic content preferences); Tool Design (infographic design preferences); Advantages of Infographic Messaging (benefits of an infographic over other approaches); Impact of Tool on Determinants of Smoking Cessation Advice Delivery (impact on barriers and enablers to delivery of smoking cessation advice in practice); and Barriers and Enablers to Quitting (impact on barriers and enablers to quitting). Patient Likert scale ratings of infographic content and format/usability were highly positive, with improvements in scores for 20/21 questions through the design process. Providers scored the infographic at 77.8% (“superior”) on the Suitability Assessment of Materials questionnaire. Conclusions We developed a user preference-based personalized biomedical risk assessment infographic to drive smoking cessation in patients with COPD. Our findings suggest that this tool could impact behavioural determinants of provider smoking-cessation advice delivery, while increasing patient quit motivation. Impacts of the tool on provider care, patient motivation to quit, and smoking cessation success should now be evaluated in real-world settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00283-1.
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Affiliation(s)
- Samir Gupta
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. .,Division of Respirology, Department of Medicine, St. Michael's Hospital, Suite 6044, Bond Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - Puru Panchal
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,UBC Centre for Heart Lung Innovation, St Paul's Hospital, Providence Building, Vancouver, BC, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Parisa Ghanouni
- Faculty of Health, School of Occupational Therapy, Halifax, NS, Canada
| | - Don Sin
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Providence Building, Vancouver, BC, Canada.,Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Smita Pakhale
- Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Teresa To
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada
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Clair C, Mueller Y, Livingstone‐Banks J, Burnand B, Camain J, Cornuz J, Rège‐Walther M, Selby K, Bize R. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database Syst Rev 2019; 3:CD004705. [PMID: 30912847 PMCID: PMC6434771 DOI: 10.1002/14651858.cd004705.pub5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND A possible strategy for increasing smoking cessation rates could be to provide smokers with feedback on the current or potential future biomedical effects of smoking using, for example, measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer or other diseases. OBJECTIVES The main objective was to determine the efficacy of providing smokers with feedback on their exhaled CO measurement, spirometry results, atherosclerotic plaque imaging, and genetic susceptibility to smoking-related diseases in helping them to quit smoking. SEARCH METHODS For the most recent update, we searched the Cochrane Tobacco Addiction Group Specialized Register in March 2018 and ClinicalTrials.gov and the WHO ICTRP in September 2018 for studies added since the last update in 2012. SELECTION CRITERIA Inclusion criteria for the review were: a randomised controlled trial design; participants being current smokers; interventions based on a biomedical test to increase smoking cessation rates; control groups receiving all other components of intervention; and an outcome of smoking cessation rate at least six months after the start of the intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We expressed results as a risk ratio (RR) for smoking cessation with 95% confidence intervals (CI). Where appropriate, we pooled studies using a Mantel-Haenszel random-effects method. MAIN RESULTS We included 20 trials using a variety of biomedical tests interventions; one trial included two interventions, for a total of 21 interventions. We included a total of 9262 participants, all of whom were adult smokers. All studies included both men and women adult smokers at different stages of change and motivation for smoking cessation. We judged all but three studies to be at high or unclear risk of bias in at least one domain. We pooled trials in three categories according to the type of biofeedback provided: feedback on risk exposure (five studies); feedback on smoking-related disease risk (five studies); and feedback on smoking-related harm (11 studies). There was no evidence of increased cessation rates from feedback on risk exposure, consisting mainly of feedback on CO measurement, in five pooled trials (RR 1.00, 95% CI 0.83 to 1.21; I2 = 0%; n = 2368). Feedback on smoking-related disease risk, including four studies testing feedback on genetic markers for cancer risk and one study with feedback on genetic markers for risk of Crohn's disease, did not show a benefit in smoking cessation (RR 0.80, 95% CI 0.63 to 1.01; I2 = 0%; n = 2064). Feedback on smoking-related harm, including nine studies testing spirometry with or without feedback on lung age and two studies on feedback on carotid ultrasound, also did not show a benefit (RR 1.26, 95% CI 0.99 to 1.61; I2 = 34%; n = 3314). Only one study directly compared multiple forms of measurement with a single form of measurement, and did not detect a significant difference in effect between measurement of CO plus genetic susceptibility to lung cancer and measurement of CO only (RR 0.82, 95% CI 0.43 to 1.56; n = 189). AUTHORS' CONCLUSIONS There is little evidence about the effects of biomedical risk assessment as an aid for smoking cessation. The most promising results relate to spirometry and carotid ultrasound, where moderate-certainty evidence, limited by imprecision and risk of bias, did not detect a statistically significant benefit, but confidence intervals very narrowly missed one, and the point estimate favoured the intervention. A sensitivity analysis removing those studies at high risk of bias did detect a benefit. Moderate-certainty evidence limited by risk of bias did not detect an effect of feedback on smoking exposure by CO monitoring. Low-certainty evidence, limited by risk of bias and imprecision, did not detect a benefit from feedback on smoking-related risk by genetic marker testing. There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment.
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Affiliation(s)
- Carole Clair
- University of LausanneCenter for Primary Care and Public HealthRue du Bugnon 44LausanneSwitzerland1011
| | - Yolanda Mueller
- University of LausanneCenter for Primary Care and Public HealthRue du Bugnon 44LausanneSwitzerland1011
| | | | - Bernard Burnand
- University of LausanneCenter for Primary Care and Public HealthRue du Bugnon 44LausanneSwitzerland1011
| | - Jean‐Yves Camain
- University of LausanneCenter for Primary Care and Public HealthRue du Bugnon 44LausanneSwitzerland1011
| | - Jacques Cornuz
- University of LausanneCenter for Primary Care and Public HealthRue du Bugnon 44LausanneSwitzerland1011
| | - Myriam Rège‐Walther
- University of LausanneCenter for Primary Care and Public HealthRue du Bugnon 44LausanneSwitzerland1011
| | - Kevin Selby
- University of LausanneCenter for Primary Care and Public HealthRue du Bugnon 44LausanneSwitzerland1011
| | - Raphaël Bize
- University of LausanneCenter for Primary Care and Public HealthRue du Bugnon 44LausanneSwitzerland1011
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Jaén-Moreno MJ, Feu N, Redondo-Écija J, Montiel FJ, Gómez C, Del Pozo GI, Alcalá JÁ, Gutiérrez-Rojas L, Balanzá-Martinez V, Chauca GM, Carrión L, Osuna MI, Sánchez MD, Caro I, Ayora M, Valdivia F, López MS, Poyato JM, Sarramea F. Smoking cessation opportunities in severe mental illness (tobacco intensive motivational and estimate risk - TIMER-): study protocol for a randomized controlled trial. Trials 2019; 20:47. [PMID: 30642365 PMCID: PMC6332915 DOI: 10.1186/s13063-018-3139-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/15/2018] [Indexed: 01/19/2023] Open
Abstract
Background There is an increased risk of premature death in people with severe mental illness (SMI). Respiratory disorders and cardiovascular disease are leading causes of increased mortality rates in these patients, and tobacco consumption remains the most preventable risk factor involved. Developing new tools to motivate patients towards cessation of smoking is a high priority. Information on the motivational value of giving the lung age and prevention opportunities is unknown in this high-risk population. Methods/design This article describes in detail a protocol developed to evaluate an intensive motivational tool, based on the individual risks of pulmonary damage and prevention opportunities. It is designed as a randomized, 12-month, follow-up, multicenter study. A minimum of 204 smokers will be included, aged 40 years and older, all of whom are patients diagnosed with either schizophrenia or bipolar disorder (BD). Chronic obstructive pulmonary disease (COPD) will be evaluated using spirometry, and the diagnosis will then be validated by a pneumologist and the lung age estimated. Based on this value, a motivational message about prevention will be issued for the intervention group, which will be reinforced by individualized text messages over a period of 3 months. The efficacy of the method and the pulmonary damage variables will be evaluated: smoking cessation at the end of follow-up will be confirmed by cooximetry, and the COPD diagnosis and the severity of the staging for disease will be assessed. Discussion In the context of community care, screening and early detection of lung damage could potentially be used, together with mobile technology, in order to produce a prevention message, which may provide patients with SMI with a better chance of quitting smoking. Trial registration ClinicalTrials.gov, ID: NCT03583203. Registered on 11 July 2018. Trial status: recruitment.
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Affiliation(s)
- María José Jaén-Moreno
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departamento de Ciencias Sociosanitarias, Radiología y Medicina Física, Universidad de Córdoba, Córdoba, Spain
| | - Nuria Feu
- Unidad de Gestión Clínica de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Justa Redondo-Écija
- Unidad de Drogas y Adicciones, Instituto Provincial de Bienestar Social, Diputación de Córdoba, Córdoba, Spain
| | | | - Cristina Gómez
- Unidad de Gestión Clínica de Salud Mental, Complejo Hospitalario de Jaén, Córdoba, Spain
| | - Gloria I Del Pozo
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal s/n 14014, Córdoba, Spain
| | - Jose Ángel Alcalá
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal s/n 14014, Córdoba, Spain
| | - Luis Gutiérrez-Rojas
- Grupo de Investigación Psiquiatría y Neurociencias (CTS-549), Instituto de Neurociencias, Universidad de Granada, Granada, Spain
| | - Vicente Balanzá-Martinez
- Área de Psiquiatría y Psicología Médica. Departamento de Medicina, Servicio de Psiquiatría, Universidad de Valencia, CIBERSAM, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Geli Marie Chauca
- Unidad de Gestión Clínica de Salud Mental, Hospital Infanta Margarita, Cabra, Spain
| | - Laura Carrión
- Unidad de Gestión Clínica de Salud Mental, Hospital Infanta Margarita, Cabra, Spain
| | - Maria Isabel Osuna
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - María Dolores Sánchez
- Unidad de Gestión Clínica de Salud Mental, Complejo Hospitalario de Jaén, Córdoba, Spain
| | - Inmaculada Caro
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Miriam Ayora
- Unidad de Psiquiatría del niño y del adolescente, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Francisca Valdivia
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal s/n 14014, Córdoba, Spain
| | - María Soledad López
- Unidad de Gestión Clínica de Salud Mental, Hospital Infanta Margarita, Cabra, Spain
| | - Jose Manuel Poyato
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal s/n 14014, Córdoba, Spain
| | - Fernando Sarramea
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain. .,Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal s/n 14014, Córdoba, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, 33006, Oviedo, Spain.
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Dingel MJ, Ostergren J, Heaney K, Koenig BA, McCormick J. "I don't have to know why it snows, I just have to shovel it!": Addiction Recovery, Genetic Frameworks, and Biological Citizenship. BIOSOCIETIES 2017; 12:568-587. [PMID: 29552089 PMCID: PMC5851475 DOI: 10.1057/s41292-017-0045-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The gene has infiltrated the way citizens perceive themselves and their health. However, there is scant research that explores the ways genetic conceptions infiltrate individuals' understanding of their own health as it relates to a behavioral trait, like addiction. Do people seeking treatment for addiction ground their self-perception in biology in a way that shapes their experiences? We interviewed 63 participants in addiction treatment programs, asking how they make meaning of a genetic understanding of addiction in the context of their recovery, and in dealing with the stigma of addiction. About two-thirds of people in our sample did not find a genetic conception of addiction personally useful to them in treatment, instead believing that the cause was irrelevant to their daily struggle to remain abstinent. One-third of respondents believed that an individualized confirmation of a genetic predisposition to addiction would facilitate their dealing with feelings of shame and accept treatment. The vast majority of our sample believed that a genetic understanding of addiction would reduce the stigma associated with addiction, which demonstrates the perceived power of genetic explanations in U.S. society. Our results indicate that respondents (unevenly) ground their self-perception of themselves as an addicted individual in biology.
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Affiliation(s)
- Molly J Dingel
- University of Minnesota Rochester, 300 University Square, 111 South Broadway, Rochester, Minnesota, 55904, USA, , (507) 258-8206
| | - Jenny Ostergren
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, Michigan, USA,
| | - Kathleen Heaney
- Hennepin County Medical Center, 701 Park Avenue, Minneapolis, Minnesota, USA,
| | - Barbara A Koenig
- University of California, San Francisco, Institute for Health & Aging, 3333 Calif. St, Laurel Heights, San Francisco CA 94143,
| | - Jennifer McCormick
- Pennsylvania State University, 1743C Humanities, Hershey Medical Center, Hershey, PA 17033
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Preguntas y respuestas relacionadas con tabaquismo en pacientes con EPOC. Aplicación de metodología con formato PICO. Arch Bronconeumol 2017; 53:622-628. [DOI: 10.1016/j.arbres.2017.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/05/2017] [Accepted: 04/09/2017] [Indexed: 01/06/2023]
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McClure JB, Heffner J, Hohl S, Klasnja P, Catz SL. Design Considerations for mHealth Programs Targeting Smokers Not Yet Ready to Quit: Results of a Sequential Mixed-Methods Study. JMIR Mhealth Uhealth 2017; 5:e31. [PMID: 28283465 PMCID: PMC5381767 DOI: 10.2196/mhealth.6845] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/12/2016] [Accepted: 02/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background Mobile health (mHealth) smoking cessation programs are typically designed for smokers who are ready to quit smoking. In contrast, most smokers want to quit someday but are not yet ready to quit. If mHealth apps were designed for these smokers, they could potentially encourage and assist more people to quit smoking. No prior studies have specifically examined the design considerations of mHealth apps targeting smokers who are not yet ready to quit. Objective To inform the user-centered design of mHealth apps for smokers who were not yet ready to quit by assessing (1) whether these smokers were interested in using mHealth tools to change their smoking behavior; (2) their preferred features, functionality, and content of mHealth programs addressing smoking; and (3) considerations for marketing or distributing these programs to promote their uptake. Methods We conducted a sequential exploratory, mixed-methods study. Qualitative interviews (phase 1, n=15) were completed with a demographically diverse group of smokers who were smartphone owners and wanted to quit smoking someday, but not yet. Findings informed a Web-based survey of smokers from across the United States (phase 2, n=116). Data were collected from April to September, 2016. Results Findings confirmed that although smokers not yet ready to quit are not actively seeking treatment or using cessation apps, most would be interested in using these programs to help them reduce or change their smoking behavior. Among phase 2 survey respondents, the app features, functions, and content rated most highly were (1) security of personal information; (2) the ability to track smoking, spending, and savings; (3) content that adaptively changes with one’s needs; (4) the ability to request support as needed; (5) the ability to earn and redeem awards for program use; (6) guidance on how to quit smoking; and (7) content specifically addressing management of nicotine withdrawal, stress, depression, and anxiety. Results generally did not vary by stage of change for quitting smoking (precontemplation vs contemplation). The least popular feature was the ability to share progress via social media. Relevant to future marketing or distribution considerations, smokers were price-sensitive and valued empirically validated programs. Program source, expert recommendations, and user ratings were also important considerations. Conclusions Smokers who are not yet ready to quit represent an important target group for intervention. Study findings suggest that many of these individuals are receptive to using mHealth tools to reduce or quit smoking, despite not having made a commitment to quit yet. The preferences for specific mHealth intervention features, functionality, and content outlined in this paper can aid addiction treatment experts, design specialists, and software developers interested in creating engaging interventions for smokers who want to quit in the future but are not yet committed to this important health goal.
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Affiliation(s)
- Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), Seattle, WA, United States
| | - Jaimee Heffner
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Sarah Hohl
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,School of Public Health, University of Washington, Seattle, WA, United States
| | - Predrag Klasnja
- Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), Seattle, WA, United States
| | - Sheryl L Catz
- Betty Irene School of Nursing, University of California, Davis, Sacramento, CA, United States
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Dingel MJ, Ostergren J, McCormick JB, Hammer R, Koenig BA. The media and behavioral genetics: Alternatives coexisting with addiction genetics. SCIENCE, TECHNOLOGY & HUMAN VALUES 2015; 40:459-486. [PMID: 26392644 PMCID: PMC4574304 DOI: 10.1177/0162243914558491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
To understand public discourse in the U.S. on genetic causation of behavioral disorders, we analyzed media representations of genetic research on addiction published between 1990 and 2010. We conclude first that the media simplistically represent biological bases of addiction and willpower as being mutually exclusive: behaviors are either genetically determined, or they are a choice. Second, most articles provide only cursory or no treatment of the environmental contribution. A media focus on genetics directs attention away from environmental factors. Rhetorically, media neglect the complexity underlying of the etiology of addiction and direct focus back toward individual causation and responsibility.
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Affiliation(s)
| | - Jenny Ostergren
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | | | - Barbara A. Koenig
- University of California, San Francisco, Institute for Health & Aging, San Francisco, CA, USA
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Balcells E, Gimeno-Santos E, de Batlle J, Ramon MA, Rodríguez E, Benet M, Farrero E, Ferrer A, Guerra S, Ferrer J, Sauleda J, Barberà JA, Agustí À, Rodriguez-Roisin R, Gea J, Antó JM, Garcia-Aymerich J. Characterisation and prognosis of undiagnosed chronic obstructive pulmonary disease patients at their first hospitalisation. BMC Pulm Med 2015; 15:4. [PMID: 25595204 PMCID: PMC4360934 DOI: 10.1186/1471-2466-15-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 01/08/2015] [Indexed: 11/22/2022] Open
Abstract
Background Under-diagnosis of COPD is an important unmet medical need. We investigated the characteristics and prognosis of hospitalised patients with undiagnosed COPD. Methods The PAC-COPD cohort included 342 COPD patients hospitalised for the first time for an exacerbation of COPD (2004–2006). Patients were extensively characterised using sociodemographic, clinical and functional variables, and the cohort was followed-up through 2008. We defined “undiagnosed COPD” by the absence of any self-reported respiratory disease and regular use of any pharmacological respiratory treatment. Results Undiagnosed COPD was present in 34% of patients. They were younger (mean age 66 vs. 68 years, p = 0.03), reported fewer symptoms (mMRC dyspnoea score, 2.1 vs. 2.6, p < 0.01), and had a better health status (SGRQ total score, 29 vs. 40, p < 0.01), milder airflow limitation (FEV1% ref., 59% vs. 49%, p < 0.01), and fewer comorbidities (two or more, 40% vs. 56%, p < 0.01) when compared with patients with an established COPD diagnosis. Three months after hospital discharge, 16% of the undiagnosed COPD patients had stopped smoking (vs. 5%, p = 0.019). During follow-up, annual hospitalisation rates were lower in undiagnosed COPD patients (0.14 vs. 0.25, p < 0.01); however, this difference disappeared after adjustment for severity. Mortality was similar in both groups. Conclusions Undiagnosed COPD patients have less severe disease and lower risk of re-hospitalisation when compared with hospitalised patients with known COPD. Electronic supplementary material The online version of this article (doi:10.1186/1471-2466-15-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Judith Garcia-Aymerich
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Doctor Aiguader 88, 08003 Barcelona, Spain.
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Shofer S, Beyea M, Li S, Bastian LA, Wahidi MM, Kelley M, Lipkus IM. Feasibility of using an epigenetic marker of risk for lung cancer, methylation of p16, to promote smoking cessation among US veterans. BMJ Open Respir Res 2014; 1:e000032. [PMID: 25478181 PMCID: PMC4212704 DOI: 10.1136/bmjresp-2014-000032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 05/27/2014] [Accepted: 06/08/2014] [Indexed: 11/29/2022] Open
Abstract
Introduction Providing smokers feedback using epigenetic markers of lung cancer risk has yet to be tested as a strategy to motivate smoking cessation. Epigenetic modification of Rb-p16 (p16) due to tobacco exposure is associated with increased risk of developing lung cancer. This study examined the acceptance of testing for methylated p16 and the understanding of test results in smokers at risk for development of lung cancer. Methods Thirty-five current smokers with airways obstruction viewed an educational presentation regarding p16 function followed by testing for the presence of methylated p16 in sputum. Participants were offered smoking cessation assistance and asked to complete surveys at the time of enrolment regarding their understanding of the educational material, perception of risk associated with smoking and desire to quit. Participants were notified of their test result and follow-up surveys were administered 2 and 10 weeks after notification of their test result. Results Twenty per cent of participants had methylated p16. Participants showed high degree of understanding of educational materials regarding the function and risk associated with p16 methylation. Sixty-seven per cent and 57% of participants with low-risk and high-risk test results, respectively, reported that the information was more likely to motivate them to quit smoking. Smoking cessation rates were similar between methylated and non-methylated participants. Conclusions Testing for an epigenetic marker of lung cancer risk is accepted and understood by active smokers. A low-risk test result does not decrease motivation to stop smoking. Trial registration number NCT01038492.
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Affiliation(s)
- Scott Shofer
- Pulmonary Section , Durham Veteran Affairs Medical Center , Durham, North Carolina , USA ; Division of Pulmonary, Allergy, and Critical Care , Duke University Medical Center , Durham, North Carolina , USA
| | | | - Sufeng Li
- Division of Hematology/Oncology , Duke University Medical Center , Durham, North Carolina , USA
| | - Lori A Bastian
- Department of Internal Medicine , Veteran Administration Connecticut Healthcare System , West Haven, Connecticut , USA ; Department of Internal Medicine , University of Connecticut Health Center , Farmington, Connecticut , USA
| | - Momen M Wahidi
- Division of Pulmonary, Allergy, and Critical Care , Duke University Medical Center , Durham, North Carolina , USA
| | - Michael Kelley
- Division of Hematology/Oncology , Duke University Medical Center , Durham, North Carolina , USA ; Hematology and Oncology Section, Durham Veterans Affairs Medical Center, Durham, North Carolina , USA
| | - Isaac M Lipkus
- Duke University School of Nursing , Durham, North Carolina , USA
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Dirven JAM, Tange HJ, Muris JWM, van Haaren KMA, Vink G, van Schayck OCP. Early detection of COPD in general practice: patient or practice managed? A randomised controlled trial of two strategies in different socioeconomic environments. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 22:331-7. [PMID: 23966214 PMCID: PMC6442827 DOI: 10.4104/pcrj.2013.00070] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: The burden of chronic obstructive pulmonary disease (COPD) is high. Health benefits can be gained in primary care by early detection and preventive measures. Aims: To compare the effectiveness of two strategies for population-based early detection of COPD, taking into account different socioeconomic status (SES) settings. Methods: Practices were randomised on strategy and stratified on SES setting. The Respiratory Health Screening Questionnaire (RHSQ) was distributed to all participants. In the practice-managed condition, the practice was responsible for the whole procedure, while in the patient-managed condition, patients were responsible for calculating their RHSQ risk score and applying for a spirometry test. The main outcome measure was the rate of COPD diagnoses after screening. Results: More new COPD patients were detected in the practice-managed condition (36%) than in the patient-managed condition (18%). In low SES practices, more high-risk patients were found (16%) than in moderate-to-high SES practices (9%). Recalculated for a standard Dutch practice (2,350 patients), the yield would be 8.9 new COPD diagnoses, which is a 20% increase of known cases. Conclusions: The practice-managed variant of this screening procedure shows a substantial yield of new COPD diagnoses for both low and moderate-to-high SES practices.
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Affiliation(s)
- Joseph A M Dirven
- Caphri School of Public Health and Primary Care, Department of General Practice, Maastricht University Medical Centre, Maastricht, The Netherlands
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Ostergren JE, Hammer RR, Dingel MJ, Koenig BA, McCormick JB. Challenges in translational research: the views of addiction scientists. PLoS One 2014; 9:e93482. [PMID: 24705385 PMCID: PMC3976268 DOI: 10.1371/journal.pone.0093482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 03/06/2014] [Indexed: 12/04/2022] Open
Abstract
Objectives To explore scientists' perspectives on the challenges and pressures of translating research findings into clinical practice and public health policy. Methods We conducted semi-structured interviews with a purposive sample of 20 leading scientists engaged in genetic research on addiction. We asked participants for their views on how their own research translates, how genetic research addresses addiction as a public health problem and how it may affect the public's view of addiction. Results Most scientists described a direct translational route for their research, positing that their research will have significant societal benefits, leading to advances in treatment and novel prevention strategies. However, scientists also pointed to the inherent pressures they feel to quickly translate their research findings into actual clinical or public health use. They stressed the importance of allowing the scientific process to play out, voicing ambivalence about the recent push to speed translation. Conclusions High expectations have been raised that biomedical science will lead to new prevention and treatment modalities, exerting pressure on scientists. Our data suggest that scientists feel caught in the push for immediate applications. This overemphasis on rapid translation can lead to technologies and applications being rushed into use without critical evaluation of ethical, policy, and social implications, and without balancing their value compared to public health policies and interventions currently in place.
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Affiliation(s)
- Jenny E. Ostergren
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rachel R. Hammer
- Biomedical Ethics Research Unit and Mayo Clinic College of Medicine, Rochester, Minnesota, United States of America
| | - Molly J. Dingel
- Center for Learning Innovation, University of Minnesota Rochester, Rochester, Minnesota, United States of America
| | - Barbara A. Koenig
- Departments of Social & Behavioral Sciences, and Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jennifer B. McCormick
- Divisions of General Internal Medicine & Health Care Policy Research, and Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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Acceptability of screening for early detection of liver disease in hazardous/harmful drinkers in primary care. Br J Gen Pract 2014; 63:e516-22. [PMID: 23972192 DOI: 10.3399/bjgp13x670642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND It is estimated that one-quarter of adults in the UK drink at harmful/hazardous levels leading to increased mortality and alcohol liver disease (ALD). The Alcohol Liver Disease Detection Study (ALDDeS) aimed to test out in primary care the feasibility of alcohol misuse screening in adults, using the AUDIT questionnaire, and to assess screening harmful/hazardous alcohol users for ALD using newer non-invasive serum markers of fibrosis. AIM To explore patients' experiences of taking part in ALDDeS and understanding of the delivery and process of screening for ALD using self-report questionnaires and feedback of liver fibrosis risk using levels of non-invasive serum markers. DESIGN AND SETTING A nested qualitative study based in five primary care practices in the UK. METHOD From a sample of patients who were identified as drinking at harmful/hazardous levels, 30 participants were identified by maximum variation sampling for qualitative in-depth interviews. Using the principles of constant comparison the transcribed interviews were thematically analysed. RESULTS Receiving a postal AUDIT questionnaire was viewed as acceptable by participants. For some completing the AUDIT increased awareness of their hazardous alcohol use and a positive blood test indicating liver fibrosis was a catalyst for behaviour change. For others, a negative blood test result provided a licence to continue drinking at hazardous levels. A limited understanding of safe drinking and of ALD was common. CONCLUSION Educational and training needs of primary care professionals must be taken into account, so that patients with marker levels indicating low risk of fibrosis are correctly informed about the likely risks of continuing to drink at the same levels.
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Brunette MF, Ferron JC, Drake RE, Devitt TS, Geiger PT, McHugo GJ, Jonikas JA, Cook JA. Carbon monoxide feedback in a motivational decision support system for nicotine dependence among smokers with severe mental illnesses. J Subst Abuse Treat 2013; 45:319-24. [DOI: 10.1016/j.jsat.2013.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 03/13/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
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Dirven JAM, Tange HJ, Muris JWM, van Haaren KMA, Vink G, van Schayck OCP. Early detection of COPD in general practice: implementation, workload and socioeconomic status. A mixed methods observational study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:338-43. [PMID: 23966213 PMCID: PMC6442826 DOI: 10.4104/pcrj.2013.00071] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/24/2013] [Accepted: 06/04/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is underdiagnosed in general practice. Our aim was to implement a population-based approach for the early detection of COPD and to assess its impact on primary care workload and costs, and the influence of socioeconomic status (SES). METHODS An observational study with mixed methods was performed in 10 Dutch general practices of either low or moderate to high SES. The Respiratory Health Screening Questionnaire was posted during a three-month period to all persons aged 45, 55, and 65 years (one age group per month). The practices calculated the risk, and patients at high risk of COPD were invited for spirometry at the practice. The general practitioner used the spirometric results and a consultation to establish a clinical diagnosis. Qualitative and quantitative data on workload, cost, and barriers were evaluated. RESULTS Ten practices returned 293 (35.3%) COPD risk tests for the three age groups. Participants from low SES practices responded better than those from moderate to high SES practices (40.8% vs. 30.5%). In practices with low SES 17.9% of the tests indicated high risk compared with 16.1% in practices with moderate to high SES. Nine patients (23%) were newly diagnosed with COPD. The healthcare providers' extra workload averaged 18.5 hours during the three months for one standard practice. The average cost of this survey programme (three age groups in three months) was €520 for low SES practices and €398 for moderate to high SES practices. All healthcare providers affirmed that the extra workload in this survey model is acceptable and feasible when finances are compensated. CONCLUSIONS Early detection of COPD is feasible in daily life primary care. In moderate to high SES practices the costs of detecting COPD were less than in low SES practices.
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Affiliation(s)
- Joseph AM Dirven
- Caphri School of Public Health and Primary Care, Department of General Practice, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Huibert J Tange
- Caphri School of Public Health and Primary Care, Department of General Practice, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jean WM Muris
- Caphri School of Public Health and Primary Care, Department of General Practice, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Gerrit Vink
- Dutch Lung Foundation, Amersfoort, The Netherlands
| | - Onno CP van Schayck
- Caphri School of Public Health and Primary Care, Department of General Practice, Maastricht University Medical Centre, Maastricht, The Netherlands
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de Viron S, Malats N, Van der Heyden J, Van Oyen H, Brand A. Environmental and Genomic Factors as well as Interventions Influencing Smoking Cessation: A Systematic Review of Reviews and a Proposed Working Model. Public Health Genomics 2013; 16:159-73. [DOI: 10.1159/000351453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 04/18/2013] [Indexed: 11/19/2022] Open
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Bize R, Burnand B, Mueller Y, Rège-Walther M, Camain JY, Cornuz J. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database Syst Rev 2012; 12:CD004705. [PMID: 23235615 DOI: 10.1002/14651858.cd004705.pub4] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e.g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer. OBJECTIVES To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. SEARCH METHODS For the most recent update, we searched the Cochrane Collaboration Tobacco Addiction Group Specialized Register in July 2012 for studies added since the last update in 2009. SELECTION CRITERIA Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention. DATA COLLECTION AND ANALYSIS Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. Results were expressed as a relative risk (RR) for smoking cessation with 95% confidence intervals (CI). Where appropriate, a pooled effect was estimated using a Mantel-Haenszel fixed-effect method. MAIN RESULTS We included 15 trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that carbon monoxide (CO) measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other 11 trials due to the presence of substantial clinical heterogeneity. Of the remaining 11 trials, two trials detected statistically significant benefits: one trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12, 95% CI 1.24 to 3.62) and one trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77, 95% CI 1.04 to 7.41) but enrolled a population of light smokers and was judged to be at unclear risk of bias in two domains. Nine further trials did not detect significant effects. One of these tested CO feedback alone and CO combined with genetic susceptibility as two different interventions; none of the three possible comparisons detected significant effects. One trial used CO measurement, one used ultrasonography of carotid arteries and two tested for genetic markers. The four remaining trials used a combination of CO and spirometry feedback in different settings. AUTHORS' CONCLUSIONS There is little evidence about the effects of most types of biomedical tests for risk assessment on smoking cessation. Of the fifteen included studies, only two detected a significant effect of the intervention. Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial but the evidence is not optimal. A trial of carotid plaque screening using ultrasound also detected a significant effect, but a second larger study of a similar feedback mechanism did not detect evidence of an effect. Only two pairs of studies were similar enough in terms of recruitment, setting, and intervention to allow meta-analyses; neither of these found evidence of an effect. Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment. There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment.
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Affiliation(s)
- Raphaël Bize
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
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An Evaluation of a Novel Biomarker Feedback Intervention on Smoking Cessation: A Pilot Study. J Smok Cessat 2012. [DOI: 10.1017/jsc.2012.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cessation is the single most important decision smokers can make to improve their health. The aim of this study was to investigate the effects of a novel biomarker feedback intervention on smoking cessation. Participants (n = 14) were block matched into two groups – biomarker feedback and standard care (control) – and encouraged to stop smoking without the support of any pharmacological aids. All participants received standard smoking cessation advice and also had physiological measures collected during both rest and sub-maximal exercise testing at baseline, week 6 and week 12. The standard care group only received the smoking cessation advice as their intervention, whereas the biomarker feedback group were also given individual feedback in relation to their physiological results. Cessation rates were not significantly different between groups (p = 0.56) at week 12 follow-up; however, a calculation of odds ratios (OR) suggests that the biomarker feedback group was more likely to be successful when compared to standard care (OR = 4.5). Results suggest that targeting health motivations may positively influence cessation rates. Future research is needed to verify this result with a larger group.
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Dingel MJ, Karkazis K, Koenig BA. Framing Nicotine Addiction as a "Disease of the Brain": Social and Ethical Consequences. SOCIAL SCIENCE QUARTERLY 2012; 92:1363-1388. [PMID: 23476081 PMCID: PMC3589175 DOI: 10.1111/j.1540-6237.2011.00822.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES In this article, we seek to better understand how a genomic vision of addiction may influence drug prevention and treatment. Though social influences on substance use and abuse (e.g., peer and family influence, socioeconomic status) are well documented, biomedical intervention is becoming increasingly technoscientific in nature. We wish to elucidate how emphasizing biological influences on substance use may lead to a vision of addiction as a phenomenon isolated within our bodies and neurochemistry, not lived daily within a complex social web of relationships and a particular political economy, including the tobacco industry, which aggressively markets products known to cause harm. METHODS We explore the emerging view of addiction as a "disease of the brain" in open-ended interviews with 86 stakeholders from the fields of nicotine research and tobacco control. Interview data were analyzed using standard qualitative techniques. RESULTS Most stakeholders hold a medicalized view of addiction. Though environmental variables are understood to be a primary cause of smoking initiation, the speed and strength with which addiction occurs is understood to be a largely biological process. Though stakeholders believe that an increased focus on addiction as a disease of the brain is not likely to lead to widespread unrealistic expectations for cessation therapies, they remain concerned that it may reinforce teenagers' expectations that quitting is not difficult. Finally, stakeholder responses indicate that genetic and neuroscientific research is unlikely to increase or decrease stigmatization, but will be used by interest groups to buttress their existing views of the stigma associated with smoking. CONCLUSION We argue that the main potential harms of focusing on biological etiology stem from a concept of addiction that is disassociated from social context. Focusing on genetic testing and brain scans may lead one to overemphasize pharmaceutical "magic bullet cures" and underemphasize, and underfund, more traditional therapies and public health prevention strategies that have proven to be effective. Genetic research on addiction may fundamentally change our conception of deviance and our identities, and may thus transform our susceptibility to substance use into something isolated in our biology, not embedded in a biosocial context.
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Najafzadeh M, Marra CA, Lynd LD, Sadatsafavi M, FitzGerald JM, McManus B, Sin D. Future impact of various interventions on the burden of COPD in Canada: a dynamic population model. PLoS One 2012; 7:e46746. [PMID: 23071626 PMCID: PMC3469627 DOI: 10.1371/journal.pone.0046746] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/28/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a growing economic burden worldwide. Smoking cessation is thought to be the single most effective way of reducing the economic burden of COPD. The impact of other strategies such as interventions that predict risk of disease, reduce progression of disease, or reduce exacerbations has not been systematically studied. OBJECTIVES We estimated the economic and clinical burden of COPD over the next 25 years in Canada and the impact of three potential interventions (screening test for predisposition to COPD, new drugs to avoid progression into more severe disease stages, and predictive test for exacerbations) on COPD burden. METHODS Using a dynamic simulation model, we projected the total burden of COPD (cost, morbidity, and mortality) from 2011 to 2035 using the population of Canada as a case study. The model stratified population based on sex, age, smoking status, respiratory symptoms, and their COPD stage. The cost and quality adjusted life years (QALYs) associated with each intervention were estimated. RESULTS The model indicates that annual societal cost of COPD is $4.52 billion (B) Canadian dollars in 2011 and will reach $3.61B ($7.33B undiscounted) per year in 2035. Over the next 25 years, COPD will be responsible for approximately $101.4B in societal costs ($147.5B undiscounted) and 12.9 million QALYs lost (19.0 million undiscounted). Our results suggested that the best strategy to reduce the financial burden of COPD is by reducing exacerbations. Smoking cessation, while it is the cornerstone of COPD prevention, has only a modest effect in attenuating the financial burden of COPD over the next 25 years in Western countries such as Canada. CONCLUSION Our data suggest that any intervention that can reduce the number of exacerbations has a substantial impact on morbidity and costs of COPD and should be considered in conjunction with the ongoing efforts to reduce smoking rates.
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Affiliation(s)
- Mehdi Najafzadeh
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Carlo A. Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Larry D. Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - J. Mark FitzGerald
- Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- The Institute for Heart and Lung Health (the UBC James Hogg Research Laboratories), Vancouver, British Columbia, Canada
| | - Bruce McManus
- Department of Pathology and Laboratory Medicine, University of British Columbia, and The Prevention of Organ Failure Center of Excellence, Vancouver, British Columbia, Canada
- The Institute for Heart and Lung Health (the UBC James Hogg Research Laboratories), Vancouver, British Columbia, Canada
| | - Don Sin
- Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- The Institute for Heart and Lung Health (the UBC James Hogg Research Laboratories), Vancouver, British Columbia, Canada
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Coleman T, Chamberlain C, Davey MA, Cooper SE, Leonardi-Bee J. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev 2012:CD010078. [PMID: 22972148 DOI: 10.1002/14651858.cd010078] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Smoking in pregnancy is a substantial public health problem. When used by non-pregnant smokers, pharmacotherapies [nicotine replacement therapy (NRT), bupropion and varenicline] are effective treatments for smoking cessation, however, their efficacy and safety in pregnancy remains unknown. OBJECTIVES To determine the efficacy and safety of smoking cessation pharmacotherapies, including NRT, varenicline and bupropion (or any other medications) when used to support smoking cessation in pregnancy. SEARCH METHODS We searched the Pregnancy and Childbirth Group's Trials Register (5 March 2012), checked references of retrieved studies and contacted authors in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) with designs that permit the independent effects of any type of NRT (e.g. patch, gum etc.) or any other pharmacotherapy on smoking cessation to be ascertained were eligible for inclusion. Trials must provide very similar (ideally identical) levels of behavioural support or cognitive behaviour therapy (CBT) to participants in active drug and comparator trial arms.The following RCT designs are considered acceptable.Placebo RCTs: any form of NRT or other pharmacotherapy, with or without behavioural support/CBT, or brief advice compared with placebo NRT and additional support of similar intensity.RCTs providing a comparison between i) behavioural support/CBT or brief advice and ii) any form of NRT or other pharmacotherapy added to behavioural support of similar (ideally identical) intensity.Parallel- or cluster-randomised design trials are eligible for inclusion. However, quasi-randomised, cross-over and within-participant designs are not eligible for inclusion due to the potential biases associated with these designs. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias and extracted data. Two assessors independently extracted data and cross checked individual outcomes of this process to ensure accuracy. The primary efficacy outcome was smoking cessation in later pregnancy (in all but one trial, at or around delivery); safety was assessed by seven birth outcomes that indicated neonatal well being and we also collated data on adherence. MAIN RESULTS Six trials of NRT enrolling 1745 pregnant smokers were included; we found no trials of varenicline or bupropion. No statistically significant difference was seen for smoking cessation in later pregnancy after using NRT as compared to control (risk ratio (RR) 1.33, 95% confidence interval (CI) 0.93 to 1.91, six studies, 1745 women). Subgroup analysis comparing placebo-RCTs with those which did not use placebos found that efficacy estimates for cessation varied with trial design (placebo RCTs, RR 1.20, 95% CI 0.93 to 1.56, four studies, 1524 women; non-placebo RCTs, RR 7.81, 95% CI 1.51 to 40.35, two studies, 221 women; P value for random-effects subgroup interaction test = 0.03). There were no statistically significant differences in rates of miscarriage, stillbirth, premature birth, birthweight, low birthweight, admissions to neonatal intensive care or neonatal death between NRT or control groups. AUTHORS' CONCLUSIONS Nicotine replacement therapy is the only pharmacotherapy for smoking cessation that has been tested in RCTs conducted in pregnancy. There is insufficient evidence to determine whether or not NRT is effective or safe when used to promote smoking cessation in pregnancy or to determine whether or not using NRT has positive or negative impacts on birth outcomes. Further research evidence of efficacy and safety is needed, ideally from placebo-controlled RCTs that investigate higher doses of NRT than were tested in the included studies.
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Affiliation(s)
- Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, UK.
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Mantzari E, Vogt F, Marteau TM. The effectiveness of financial incentives for smoking cessation during pregnancy: is it from being paid or from the extra aid? BMC Pregnancy Childbirth 2012; 12:24. [PMID: 22471787 PMCID: PMC3338379 DOI: 10.1186/1471-2393-12-24] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 04/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Financial incentives appear to be effective in promoting smoking cessation in pregnancy. The mechanisms by which they might operate however, are poorly understood. The present study examines how financial incentives for smoking cessation during pregnancy may work, by exploring pregnant women’s experiences of trying to stop smoking, within and outside of a financial incentives scheme. METHODS Thirty-six (n = 36) UK-based pregnant smokers (n = 36), offered standard NHS Stop-Smoking Services, of whom twenty (n = 20) were enrolled in a financial incentives scheme for smoking cessation (n = 20) and sixteen (n = 16) were not, were interviewed about (i) their motivation to stop smoking, and (ii) the factors they perceived as influencing their quitting efforts. Framework Analysis was used to analyse the data. RESULTS Women in the two groups reported similar reasons for wanting to stop smoking during pregnancy. However, they described dissimilar experiences of the Stop-Smoking Services, which they perceived to have differentially influenced their quit attempts. Women who were incentivised reported using the services more than women who were not incentivised. In addition, they described the motivating experience of being monitored and receiving feedback on their progress. Non-incentivised women reported problems receiving the appropriate Nicotine Replacement Therapy, which they described as having a detrimental effect on their quitting efforts. CONCLUSION Women participating in a financial incentives scheme to stop smoking reported greater engagement with the Stop-Smoking Services, from which they described receiving more help in quitting than women who were not part of the scheme. These results highlight the complexity of financial incentives schemes and the intricacies surrounding the ways in which they operate to affect smoking cessation. These might involve influencing individuals’ motivation and self-regulation, changing engagement with and provision of support services, or a combination of these.
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Affiliation(s)
- Eleni Mantzari
- Department of Psychology (at Guy's), Health Psychology Section, King's College London, 5th floor Bermondsey Wing, Guy's Campus, London SE1 9RT, UK
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Bryant J, Bonevski B, Paul C, Lecathelinais C. Assessing smoking status in disadvantaged populations: is computer administered self report an accurate and acceptable measure? BMC Med Res Methodol 2011; 11:153. [PMID: 22099396 PMCID: PMC3233509 DOI: 10.1186/1471-2288-11-153] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 11/21/2011] [Indexed: 11/10/2022] Open
Abstract
Background Self report of smoking status is potentially unreliable in certain situations and in high-risk populations. This study aimed to determine the accuracy and acceptability of computer administered self-report of smoking status among a low socioeconomic (SES) population. Methods Clients attending a community service organisation for welfare support were invited to complete a cross-sectional touch screen computer health survey. Following survey completion, participants were invited to provide a breath sample to measure exposure to tobacco smoke in expired air. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Results Three hundred and eighty three participants completed the health survey, and 330 (86%) provided a breath sample. Of participants included in the validation analysis, 59% reported being a daily or occasional smoker. Sensitivity was 94.4% and specificity 92.8%. The positive and negative predictive values were 94.9% and 92.0% respectively. The majority of participants reported that the touch screen survey was both enjoyable (79%) and easy (88%) to complete. Conclusions Computer administered self report is both acceptable and accurate as a method of assessing smoking status among low SES smokers in a community setting. Routine collection of health information using touch-screen computer has the potential to identify smokers and increase provision of support and referral in the community setting.
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Affiliation(s)
- Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle, Hunter Medical Research Institute, Room 230A, Level 2, David Maddison Building, Callaghan NSW 2308 Australia.
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Effectiveness of a structured motivational intervention including smoking cessation advice and spirometry information in the primary care setting: the ESPITAP study. BMC Public Health 2011; 11:859. [PMID: 22078490 PMCID: PMC3236011 DOI: 10.1186/1471-2458-11-859] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/11/2011] [Indexed: 11/21/2022] Open
Abstract
Background There is current controversy about the efficacy of smoking cessation interventions that are based on information obtained by spirometry. The objective of this study is to evaluate the effectiveness in the primary care setting of structured motivational intervention to achieve smoking cessation, compared with usual clinical practice. Methods Discussion Application of a motivational intervention based on structured information about spirometry results, improved abstinence rates among smokers seen in actual clinical practice conditions in primary care. Trial registration ClinicalTrial.gov, number NCT01194596.
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Dingel MJ, Hicks AD, Robinson ME, Koenig BA. Integrating genetic studies of nicotine addiction into public health practice: stakeholder views on challenges, barriers and opportunities. Public Health Genomics 2011; 15:46-55. [PMID: 21757875 DOI: 10.1159/000328861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 04/29/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Will emerging genetic research strengthen tobacco control programs? In this empirical study, we interview stakeholders in tobacco control to illuminate debates about the role of genomics in public health. METHODS The authors performed open-ended interviews with 86 stakeholders from 5 areas of tobacco control: basic scientists, clinicians, tobacco prevention specialists, health payers, and pharmaceutical industry employees. Interviews were qualitatively analyzed using standard techniques. RESULTS The central tension is between the hope that an expanding genomic knowledge base will improve prevention and smoking cessation therapies and the fear that genetic research might siphon resources away from traditional and proven public health programs. While showing strong support for traditional public health approaches to tobacco control, stakeholders recognize weaknesses, specifically the difficulty of countering the powerful voice of the tobacco industry when mounting public campaigns and the problem of individuals who are resistant to treatment and continue smoking. CONCLUSIONS In order for genetic research to be effectively translated into efforts to minimize the harm of smoking-related disease, the views of key stakeholders must be voiced and disagreements reconciled. Effective translation requires honest evaluation of both the strengths and limitations of genetic approaches.
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Affiliation(s)
- M J Dingel
- University of Minnesota Rochester, Rochester, MN, USA.
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Rodriguez-Alvarez M, Torán-Monserrat P, Muñoz-Ortiz L, Negrete-Palma A, Montero-Alia JJ, Jiménez-González M, Zurilla-Leonarte E, Marina-Ortega V, Olle-Borque M, Valentin-Moya E, Cortada-Cabrera A, Tena-Domingo A, Martínez-González S, Vila-Palau V, Ramos-Ordoñez A, Rotllant-Estelrich G, Forcada-Vega C, Borrell-Thió E. Effectiveness of regular reporting of spirometric results combined with a smoking cessation advice by a primary care physician on smoking quit rate in adult smokers: a randomized controlled trial. ESPIROTAB study. BMC FAMILY PRACTICE 2011; 12:61. [PMID: 21708047 PMCID: PMC3141513 DOI: 10.1186/1471-2296-12-61] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 06/28/2011] [Indexed: 11/13/2022]
Abstract
BACKGROUND Undiagnosed airflow limitation is common in the general population and is associated with impaired health and functional status. Smoking is the most important risk factor for this condition. Although primary care practitioners see most adult smokers, few currently have spirometers or regularly order spirometry tests in these patients. Brief medical advice has shown to be effective in modifying smoking habits in a large number of smokers but only a small proportion remain abstinent after one year. The aim of this study is to evaluate the effectiveness of regular reporting of spirometric results combined with a smoking cessation advice by a primary care physician on smoking quit rate in adult smokers. METHODS/DESIGN Intervention study with a randomized two arms in 5 primary care centres. A total of 485 smokers over the age of 18 years consulting their primary care physician will be recruited.On the selection visit all participants will undergo a spirometry, peak expiratory flow rate, test of smoking dependence, test of motivation for giving up smoking and a questionnaire on socio-demographic data. Thereafter an appointment will be made to give the participants brief structured advice to give up smoking combined with a detailed discussion on the results of the spirometry. After this, the patients will be randomised and given appointment for follow up visits at 3, 6, 12 and 24 months. Both arms will receive brief structured advice and a detailed discussion of the spirometry results at visit 0. The control group will only be given brief structured advice about giving up smoking on the follow up. Cessation of smoking will be tested with the carbon monoxide test. DISCUSSION Early identification of functional pulmonary abnormalities in asymptomatic patients or in those with little respiratory symptomatology may provide "ideal educational opportunities". These opportunities may increase the success of efforts to give up smoking and may improve the opportunities of other preventive actions to minimise patient risk. Comparing adult smokers in the intervention group with those in the control group, a minimum improvement expected with respect to the rates of smoking cessation would represent a large number of avoided morbimortality. TRIAL REGISTRATION ClinicalTrials.gov: NCT01296295.
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Affiliation(s)
- Mar Rodriguez-Alvarez
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
- Primary Healthcare Research Support Unit Metropolitana Nord, Catalan Health Institute-IDIAP Jordi Gol. Camí del Mig 36, 08303 Mataró (Barcelona), Spain
| | - Pere Torán-Monserrat
- Primary Healthcare Research Support Unit Metropolitana Nord, Catalan Health Institute-IDIAP Jordi Gol. Camí del Mig 36, 08303 Mataró (Barcelona), Spain
- Primary Healthcare Centre Gatassa, Catalan Health Institute. Camí del Mig 36 (4a planta), 08303 Mataró (Barcelona), Spain
| | - Laura Muñoz-Ortiz
- Primary Healthcare Research Support Unit Metropolitana Nord, Catalan Health Institute-IDIAP Jordi Gol. Camí del Mig 36, 08303 Mataró (Barcelona), Spain
| | - Antonio Negrete-Palma
- Primary Healthcare Research Support Unit Metropolitana Nord, Catalan Health Institute-IDIAP Jordi Gol. Camí del Mig 36, 08303 Mataró (Barcelona), Spain
- Primary Healthcare Centre Gatassa, Catalan Health Institute. Camí del Mig 36 (4a planta), 08303 Mataró (Barcelona), Spain
| | - Juan José Montero-Alia
- Primary Healthcare Centre Rocafonda-Palau, Catalan Health Institute. Ronda Pintor Rafael Estrany 24, 08304 Mataró (Barcelona), Spain
| | - Mercedes Jiménez-González
- Primary Healthcare Centre La Riera, Catalan Health Institute. La Riera 7, 08302 Mataró (Barcelona), Spain
| | - Elena Zurilla-Leonarte
- Primary Healthcare Centre Gatassa, Catalan Health Institute. Camí del Mig 36 (4a planta), 08303 Mataró (Barcelona), Spain
| | - Victoria Marina-Ortega
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Montserrat Olle-Borque
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Esther Valentin-Moya
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Anna Cortada-Cabrera
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Alexis Tena-Domingo
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Silvia Martínez-González
- Primary Healthcare Centre LLefià, Catalan Health Institute. Carretera Antiga de València s/n, 08913 Badalona (Barcelona), Spain
| | - Victoria Vila-Palau
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Adriana Ramos-Ordoñez
- Primary Healthcare Centre Pineda de Mar, Catalan Health Institute. Carrer de Tarragona 49, 08397 Pineda de Mar (Barcelona), Spain
| | - Guida Rotllant-Estelrich
- Primary Healthcare Centre Canet de Mar, Catalan Health Institute. Plaça Universitat 1, 08640 Canet de Mar (Barcelona), Spain
| | - Carme Forcada-Vega
- Primary Healthcare Service Mataró-Maresme, Catalan Health Institute. Carrer Verge de Guadalupe 2, 08303 Mataró (Barcelona), Spain
| | - Eulàlia Borrell-Thió
- Primary Healthcare Research Support Unit Metropolitana Nord, Catalan Health Institute-IDIAP Jordi Gol. Camí del Mig 36, 08303 Mataró (Barcelona), Spain
- Primary Healthcare Centre Sant Roc, Catalan Health Institute. Carrer Vélez Rubio s/n, 08913 Badalona (Barcelona), Spain
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Kaminsky DA, Marcy T, Dorwaldt A, Pinckney R, DeSarno M, Solomon L, Hughes JR. Motivating smokers in the hospital pulmonary function laboratory to quit smoking by use of the lung age concept. Nicotine Tob Res 2011; 13:1161-6. [PMID: 21551248 DOI: 10.1093/ntr/ntr096] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the use of lung age to motivate a quit attempt among smokers presenting to a hospital pulmonary function testing (PFT) laboratory. METHODS Participants were randomized to receive a lung age-based motivational strategy (intervention group) versus standard care (control group). At 1 month, all participants were interviewed by telephone to determine whether they made a quit attempt. RESULTS A total of 67 participants were enrolled, and 51 completed the study. Baseline mean data included age = 52 years, 70% women, 40 pack-years of smoking, FEV(1) = 69% predicted, and lung age = 83 years. The quit attempt rates were not different between the intervention and control groups (32% vs. 24%, respectively, p = .59). There was a near significant interaction between lung age and intervention strategy (p = .089), with quit attempt rates among those with normal lung age of 18% in the intervention group versus 33% in the control group and among those with high (worse) lung age of 39% in the intervention group versus 17% in the control group; p = .38. CONCLUSIONS Using lung age to motivate smokers presenting to the PFT laboratory to quit may succeed in patients with high lung age but may undermine motivation in smokers with normal lung age. Further work is needed to refine the approach to smokers with normal lung age.
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Affiliation(s)
- David A Kaminsky
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, University of Vermont, Burlington, VT 05405, USA.
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Wu J, Sin DD. Improved patient outcome with smoking cessation: when is it too late? Int J Chron Obstruct Pulmon Dis 2011; 6:259-67. [PMID: 21814462 PMCID: PMC3144846 DOI: 10.2147/copd.s10771] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Indexed: 11/23/2022] Open
Abstract
Smoking is the leading modifiable risk factor for chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), and lung cancer. Smoking cessation is the only proven way of modifying the natural course of COPD. It is also the most effective way of reducing the risk for myocardial infarction and lung cancer. However, the full benefits of tobacco treatment may not be realized until many years of abstinence. All patients with COPD, regardless of severity, appear to benefit from tobacco treatment. Similarly, patients with recent CVD events also benefit from tobacco treatment. The risk of total mortality and rate of recurrence of lung cancer is substantially lower in smokers who manage to quit smoking following the diagnosis of early stage lung cancer or small cell lung cancer. Together, these data suggest that tobacco treatment is effective both as a primary and a secondary intervention in reducing total morbidity and mortality related to COPD, CVD, and lung cancer. In this paper, we summarize the evidence for tobacco treatment and the methods by which smoking cessation can be promoted in smokers with lung disease.
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Affiliation(s)
- Jane Wu
- Department of Medicine (Division of Respirology), The University of British Columbia, Vancouver, BC, Canada
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Hilberink SR, Jacobs JE, van Opstal S, van der Weijden T, Keegstra J, Kempers PL, Muris JW, Grol RP, de Vries H. Validation of smoking cessation self-reported by patients with chronic obstructive pulmonary disease. Int J Gen Med 2011; 4:85-90. [PMID: 21403797 PMCID: PMC3048344 DOI: 10.2147/ijgm.s15231] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The present study reports on the biochemical validation of the self-reported smoking status of patients with chronic obstructive pulmonary disease (COPD). The objective is to establish the proportion of overestimation of self-reported success rates. METHODS A cross-sectional smoking-status validation study including 60 patients with COPD who reported that they had stopped smoking. In the analysis of urine samples, a cut-off point of 50 ng/mL of cotinine was used. RESULTS At the time of biochemical validation, 55 patients reported that they had quit smoking while five patients resumed smoking. Smoking status was biochemically confirmed for 43 patients (78%) and 12 patients (22%) were classified as smokers. The sensitivity of the self- report of smoking was 29% and the specificity was 100%. CONCLUSION Many primary care patients with COPD do not provide valid information on their smoking status, which hamper adequate therapeutic interventions. Integration of biochemical validation in daily care could overcome this problem, but may harm the doctor-patient relationship.
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Affiliation(s)
- Sander R Hilberink
- IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Marteau TM, French DP, Griffin SJ, Prevost AT, Sutton S, Watkinson C, Attwood S, Hollands GJ. Effects of communicating DNA-based disease risk estimates on risk-reducing behaviours. Cochrane Database Syst Rev 2010:CD007275. [PMID: 20927756 DOI: 10.1002/14651858.cd007275.pub2] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND There are high expectations regarding the potential for the communication of DNA-based disease risk estimates to motivate behaviour change. OBJECTIVES To assess the effects of communicating DNA-based disease risk estimates on risk-reducing behaviours and motivation to undertake such behaviours. SEARCH STRATEGY We searched the following databases using keywords and medical subject headings: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4 2010), MEDLINE (1950 to April 2010), EMBASE (1980 to April 2010), PsycINFO (1985 to April 2010) using OVID SP, and CINAHL (EBSCO) (1982 to April 2010). We also searched reference lists, conducted forward citation searches of potentially eligible articles and contacted authors of relevant studies for suggestions. There were no language restrictions. Unpublished or in press articles were eligible for inclusion. SELECTION CRITERIA Randomised or quasi-randomised controlled trials involving adults (aged 18 years and over) in which one group received actual (clinical studies) or imagined (analogue studies) personalised DNA-based disease risk estimates for diseases for which the risk could plausibly be reduced by behavioural change. Eligible studies had to include a primary outcome measure of risk-reducing behaviour or motivation (e.g. intention) to alter such behaviour. DATA COLLECTION AND ANALYSIS Two review authors searched for studies and independently extracted data. We assessed risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. For continuous outcome measures, we report effect sizes as standardised mean differences (SMDs). For dichotomous outcome measures, we report effect sizes as odds ratios (ORs). We obtained pooled effect sizes with 95% confidence intervals (CIs) using the random effects model applied on the scale of standardised differences and log odds ratios. MAIN RESULTS We examined 5384 abstracts and identified 21 studies as potentially eligible. Following a full text analysis, we included 14 papers reporting results of 7 clinical studies (2 papers report on the same trial) and 6 analogue studies.Of the seven clinical studies, five assessed smoking cessation. Meta-analyses revealed no statistically significant effects on either short-term (less than 6 months) smoking cessation (OR 1.35, 95% CI 0.76 to 2.39, P = 0.31, n = 3 studies) or cessation after six months (OR 1.07, 95% CI 0.64 to 1.78, P = 0.80, n = 4 studies). Two clinical studies assessed diet and found effects that significantly favoured DNA-based risk estimates (OR 2.24, 95% CI 1.17 to 4.27, P = 0.01). No statistically significant effects were found in the two studies assessing physical activity (OR 1.03, 95% CI 0.59 to 1.80, P = 0.92) or the one study assessing medication or vitamin use aimed at reducing disease risks (OR 1.26, 95% CI 0.58 to 2.72, P = 0.56). For the six non-clinical analogue studies, meta-analysis revealed a statistically significant effect of DNA-based risk on intention to change behaviour (SMD 0.16, 95% CI 0.04 to 0.29, P = 0.01).There was no evidence that communicating DNA-based disease risk estimates had any unintended adverse effects. Two studies that assessed fear arousal immediately after the presentation of risk information did, however, report greater fear arousal in the DNA-based disease risk estimate groups compared to comparison groups.The quality of included studies was generally poor. None of the clinical or analogue studies were considered to have a low risk of bias, due to either a lack of clarity in reporting, or where details were reported, evidence of a failure to sufficiently safeguard against the risk of bias. AUTHORS' CONCLUSIONS Mindful of the weak evidence based on a small number of studies of limited quality, the results of this review suggest that communicating DNA-based disease risk estimates has little or no effect on smoking and physical activity. It may have a small effect on self-reported diet and on intentions to change behaviour. Claims that receiving DNA-based test results motivates people to change their behaviour are not supported by evidence. Larger and better-quality RCTs are needed.
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Affiliation(s)
- Theresa M Marteau
- Health Psychology Section, King's College London, 5th Floor Bermondsey Wing, Guy's Campus, London, UK, SE1 9RT
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Kotz D, Wesseling G, Aveyard P, van Schayck OCP. Smoking cessation and development of respiratory health in smokers screened with normal spirometry. Respir Med 2010; 105:243-9. [PMID: 20850286 DOI: 10.1016/j.rmed.2010.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 07/15/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Case-finding of chronic obstructive pulmonary disease (COPD) using spirometry may deter people with normal lung function from stopping smoking. The objective of this study was to observe the percentage of smokers screened with normal lung function that quit smoking. METHODS As part of a study on early detection of COPD, 518 smokers were screened with normal lung function (post-bronchodilator FEV(1)/FVC ≥ 70%). They were invited for a follow-up measurement after an average of 2.4 years. Non-smoking was validated by carbon monoxide (<10 ppm), and respiratory health related quality of life was measured with the Clinical COPD Questionnaire (CCQ). RESULTS A total of 255 participants were followed up (49%). The point prevalence rate of non-smoking at follow-up was 18% (N = 47), and 9% assuming that all non-respondents were smokers. This rate was not lower than the expected rate of quitting in the Dutch population (8-9%) and primary "care as usual" in smokers screened with abnormal lung function (10%; p > 0.05 for all comparisons). The average decline in post-bronchodilator FEV(1) was 26 mL/year, which was unrelated to smoking status at follow-up. Non-smokers showed a clinically meaningful and statistically significant (p < 0.001) improvement in CCQ respiratory symptoms (-0.96) and total score (-0.51). CONCLUSIONS Our results do not suggest that early detection of airflow limitation to motivate smoking cessation reduces the rate of quitting in smokers shown to have normal lung function. Such smokers should be advised to quit smoking on the grounds that they are likely to improve their respiratory health in the short term and reduce their risk for smoking related diseases in the long term.
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Affiliation(s)
- Daniel Kotz
- Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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McClure JB, Ludman EJ, Grothaus L, Pabiniak C, Richards J. Impact of spirometry feedback and brief motivational counseling on long-term smoking outcomes: a comparison of smokers with and without lung impairment. PATIENT EDUCATION AND COUNSELING 2010; 80:280-283. [PMID: 20434863 PMCID: PMC2897973 DOI: 10.1016/j.pec.2009.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 08/31/2009] [Accepted: 11/06/2009] [Indexed: 05/29/2023]
Abstract
OBJECTIVE We compared long-term outcomes among smokers with and without impaired lung functioning who received brief counseling highlighting their spirometric test results. METHODS Participants in this analysis all received a brief motivational intervention for smoking cessation including spirometric testing and feedback ( approximately 20 min), were advised to quit smoking, offered free access to a phone-based smoking cessation program, and followed for one year. Outcomes were analyzed for smokers with (n=99) and without (n=168) impaired lung function. RESULTS Participants with lung impairment reported greater use of self-help cessation materials at 6 months, greater use of non-study-provided counseling services at 6 and 12 months, higher 7-day PPA rates at 6 months, and were more likely to talk with their doctor about their spirometry results. CONCLUSION Further research is warranted to determine if spirometry feedback has a differential treatment effect among smokers with and without lung impairment. PRACTICE IMPLICATIONS It is premature to make practice recommendations based on these data.
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Martinet Y, Wirth N. [About interpretation of exhaled CO in smoking cessation]. Rev Mal Respir 2010; 27:285-6. [PMID: 20403536 DOI: 10.1016/j.rmr.2010.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 02/02/2010] [Indexed: 11/19/2022]
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Abstract
Chronic obstructive pulmonary disease (COPD) is a substantially underdiagnosed disorder, with the diagnosis typically missed or delayed until the condition is advanced. Spirometry is the most frequently used pulmonary function test and enables health professionals to make an objective measurement of airflow obstruction and assess the degree to which it is reversible. As a diagnostic test for COPD, spirometry is a reliable, simple, non-invasive, safe, and non-expensive procedure. Early diagnosis of COPD should provide support for smoking cessation initiatives and lead to reduction of the societal burden of the disease, but definitive confirmation of both proves elusive. Despite substantial effort and investment, implementation of quality spirometry is deficient because of several hurdles and limitations, described in this Review. All in all, spirometry is recognised as the essential test for diagnosis and monitoring of COPD.
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Affiliation(s)
- Joan B Soriano
- CIMERA (International Center for Advanced Respiratory Medicine), Recinte Hospital Joan March, Bunyola, Spain.
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