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Huang S, Wahlquist A, Dahne J. Individual Predictors of Response to A Behavioral Activation-Based Digital Smoking Cessation Intervention: A Machine Learning Approach. Subst Use Misuse 2024:1-9. [PMID: 38898605 DOI: 10.1080/10826084.2024.2369155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Background: Depression is prevalent among individuals who smoke cigarettes and increases risk for relapse. A previous clinical trial suggests that Goal2Quit, a behavioral activation-based smoking cessation mobile app, effectively increases smoking abstinence and reduces depressive symptoms. Objective: Secondary analyses were conducted on these trial data to identify predictors of success in depression-specific digitalized cessation interventions. Methods: Adult who smoked cigarettes (age = 38.4 ± 10.3, 53% women) were randomized to either use Goal2Quit for 12 weeks (N = 103), paired with a 2-week sample of nicotine replacement therapy (patch and lozenge) or to a Treatment-As-Usual (TAU) control (N = 47). The least absolute shrinkage and selection operator was utilized to identify a subset of baseline variables predicting either smoking or depression intervention outcomes. The retained predictors were then fitted via linear regression models to determine relations to each intervention outcome. Results: Relative to TAU, only individuals who spent significant time using Goal2Quit (56 ± 46 min) were more likely to reduce cigarette use by at least 50% after 12 weeks, whereas those who spent minimal time using Goal2Quit (10 ± 2 min) did not exhibit significant changes. An interaction between educational attainment and treatment group revealed that, as compared to TAU, only app users with an educational degree beyond high school exhibited significant reductions in depression. Conclusions: The findings highlight the importance of tailoring depression-specific digital cessation interventions to individuals' unique engagement needs and educational level. This study provides a potential methodological template for future research aimed at personalizing technology-based treatments for cigarette users with depressive symptoms.
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Affiliation(s)
- Siyuan Huang
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
- Hollings Cancer Center, MUSC, Charleston, South Carolina, USA
| | - Amy Wahlquist
- Center for Rural Health Research, East Tennessee State University, Johnson City, Tennessee, USA
| | - Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
- Hollings Cancer Center, MUSC, Charleston, South Carolina, USA
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Her W, Jung H, Sam Oh Y. Examining Predictors of Nicotine Dependence in Korean Adolescents : Comparing Ever Quitters and Never Quitters. J Psychoactive Drugs 2024; 56:264-271. [PMID: 36967576 DOI: 10.1080/02791072.2023.2184736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/30/2023] [Indexed: 03/29/2023]
Abstract
Despite growing research on adolescent smokers, evidence for the differences between the two smoker groups who are ever quitters and never quitters is limited. The study aimed to examine predictors of nicotine dependence (ND) in Korean adolescents by comparing ever quitters and never quitters. Data from 349 adolescents were collected through an online survey. Among respondents, most of them were male, living with families, and were enrolled at schools. Data were analyzed by dividing participants into two groups - ever quitters and never quitters. The study found that adolescents' ND was commonly predicted by smoking peers and anxiety. However, schooling status was significantly associated with ever quitters' ND only. In the total sample, never-quitters were associated with higher ND compared to ever-quitters. This study did not control for differences among ever quitters in terms of the number of attempts to quit smoking and did not significantly control age effects in the sample. Based on study results, we suggest various policy implications. Cessation intervention should be designed keeping in mind the smokers' previous quit attempts and their motivation. It is also recommended that individually tailored smoking cessation programs be used to address the heterogenous nature of the adolescents.
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Affiliation(s)
- Wonbin Her
- Department of Social Welfare, Pukyong National University, Busan, South Korea
| | - Hyejin Jung
- Department of Public Administration, Pusan National University, Busan, South Korea
| | - Young Sam Oh
- Department of Social Welfare, Pukyong National University, Busan, South Korea
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Nathan Marti C, Arora S, Loukas A. Depressive symptoms predict trajectories of electronic delivery nicotine systems, cigarette, and cannabis use across 4.5 years among college students. Addict Behav 2023; 146:107809. [PMID: 37515895 DOI: 10.1016/j.addbeh.2023.107809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND This study examined the role of depressive symptoms on trajectories of electronic nicotine delivery systems (ENDS), cigarette, and cannabis use across 4.5 years in a sample of college students aged 18-19 at the initial study wave. METHODS Participants were 2,264 students enrolled in one of 24 Texas colleges that participated in a multi-wave study between 2014 and 2019. Latent growth mixture models were fit to identify longitudinal trajectories for past 30-day ENDS, cigarette, and cannabis use over a 4.5-year period. Class membership was regressed on baseline depressive symptoms in multinomial regression models. RESULTS Four trajectory classes were identified for each product: abstainer/minimal, decreasing, increasing, and high. Depressive symptoms were associated with a greater likelihood of belonging to the decreasing, increasing, and high trajectory classes relative to the abstainer/minimal class for all products, with the exception of the increasing ENDS class and the decreasing cannabis class. DISCUSSION The findings demonstrate that there is considerable similarity across trajectories of ENDS, cigarette, and cannabis use during traditional collegiate years. Furthermore, depressive symptoms increased the likelihood of belonging to substance using trajectory classes for all products.
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Affiliation(s)
- C Nathan Marti
- Department of Kinesiology & Health Education, University of Texas at Austin, 2700 San Jacinto Blvd. D3700, Austin, TX 78712, USA.
| | - Srishty Arora
- Department of Kinesiology & Health Education, University of Texas at Austin, 2700 San Jacinto Blvd. D3700, Austin, TX 78712, USA
| | - Alexandra Loukas
- Department of Kinesiology & Health Education, University of Texas at Austin, 2700 San Jacinto Blvd. D3700, Austin, TX 78712, USA
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Dahne J, Wahlquist AE, Kustanowitz J, Natale N, Fahey M, Graboyes EM, Diaz VA, Carpenter MJ. Behavioral Activation-Based Digital Smoking Cessation Intervention for Individuals With Depressive Symptoms: Randomized Clinical Trial. J Med Internet Res 2023; 25:e49809. [PMID: 37910157 PMCID: PMC10652199 DOI: 10.2196/49809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/07/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Depression is common among adults who smoke cigarettes. Existing depression-specific cessation interventions have limited reach and are unlikely to improve smoking prevalence rates among this large subgroup of smokers. OBJECTIVE This study aimed to determine whether a mobile app-based intervention tailored for depression paired with a mailed sample of nicotine replacement therapy (NRT) is efficacious for treating depression and promoting smoking cessation. METHODS A 2-arm nationwide remote randomized clinical trial was conducted in the United States. Adults (N=150) with elevated depressive symptoms (Patient Health Questionnaire-8≥10) who smoked were enrolled. The mobile app ("Goal2Quit") provided behavioral strategies for treating depression and quitting smoking based on Behavioral Activation Treatment for Depression. Goal2Quit participants also received a 2-week sample of combination NRT. Treatment as usual participants received a self-help booklet for quitting smoking that was not tailored for depression. Primary end points included Goal2Quit usability, change in depression (Beck Depression Inventory-II) across 12 weeks, and smoking cessation including reduction in cigarettes per day, incidence of 24-hour quit attempts, floating abstinence, and 7-day point prevalence abstinence (PPA). RESULTS In total, 150 participants were enrolled between June 25, 2020, and February 23, 2022, of which 80 were female (53.3%) and the mean age was 38.4 (SD 10.3) years. At baseline, participants on average reported moderate depressive symptoms and smoked a mean of 14.7 (SD 7.5) cigarettes per day. Goal2Quit usability was strong with a mean usability rating on the System Usability Scale of 78.5 (SD 16.9), with 70% scoring above the ≥68 cutoff for above-average usability. Retention data for app use were generally strong immediately following trial enrollment and declined in subsequent weeks. Those who received Goal2Quit and the NRT sample reported lower mean depressive symptoms over the trial duration as compared to treatment as usual (difference of mean 3.72, SE 1.37 points less; P=.01). Across time points, all cessation outcomes favored Goal2Quit. Regarding abstinence, Goal2Quit participants reported significantly higher rates of 7-day PPA at weeks 4 (11% vs 0%; P=.02), 8 (7-day PPA: 12% vs 0%; P=.02), and 12 (16% vs 2%; P=.02). CONCLUSIONS A mobile app intervention tailored for depression paired with a sample of NRT was effective for depression treatment and smoking cessation. Findings support the utility of this intervention approach for addressing the currently unmet public health treatment need for tailored, scalable depression-specific cessation treatments. TRIAL REGISTRATION ClinicalTrials.gov NCT03837379; https://clinicaltrials.gov/ct2/show/NCT03837379.
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Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Amy E Wahlquist
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, United States
| | | | - Noelle Natale
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Margaret Fahey
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Evan M Graboyes
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Vanessa A Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
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Etter JF, Vera Cruz G, Khazaal Y. Predicting smoking cessation, reduction and relapse six months after using the Stop-Tabac app for smartphones: a machine learning analysis. BMC Public Health 2023; 23:1076. [PMID: 37277740 DOI: 10.1186/s12889-023-15859-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/10/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND An analysis of predictors of smoking behaviour among users of smoking cessation apps can provide useful information beyond what is already known about predictors in other contexts. Therefore, the aim of the present study was to identify the best predictors of smoking cessation, smoking reduction and relapse six months after starting to use the smartphone app Stop-Tabac. METHOD Secondary analysis of 5293 daily smokers from Switzerland and France who participated in a randomised trial testing the effectiveness of this app in 2020, with follow-up at one and six months. Machine learning algorithms were used to analyse the data. The analyses for smoking cessation included only the 1407 participants who responded after six months; the analysis for smoking reduction included only the 673 smokers at 6-month follow-up; and the analysis for relapse at 6 months included only the 502 individuals who had quit smoking after one month. RESULTS Smoking cessation after 6 months was predicted by the following factors (in this order): tobacco dependence, motivation to quit smoking, frequency of app use and its perceived usefulness, and nicotine medication use. Among those who were still smoking at follow-up, reduction in cigarettes/day was predicted by tobacco dependence, nicotine medication use, frequency of app use and its perceived usefulness, and e-cigarette use. Among those who had quit smoking after one month, relapse after six months was predicted by intention to quit, frequency of app use, perceived usefulness of the app, level of dependence and nicotine medication use. CONCLUSION Using machine learning algorithms, we identified independent predictors of smoking cessation, smoking reduction and relapse. Studies on the predictors of smoking behavior among users of smoking cessation apps may provide useful insights for the future development of these apps and future experimental studies. CLINICAL TRIAL REGISTRATION ISRCTN Registry: ISRCTN11318024, 17 May 2018. http://www.isrctn.com/ISRCTN11318024 .
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Affiliation(s)
- Jean-François Etter
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Germano Vera Cruz
- Department of Psychology, UR 7273 CRP-CPO, University of Picardie Jules Verne, Chemin du Thil, Amiens, 80025, France.
- Département de Psychiatrie, Service de médecine des addictions, Lausanne University Hospital, Rue du Bugnon 23, Lausanne, 1011, Switzerland.
| | - Yasser Khazaal
- Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland.
- Lausanne University, Lausanne, Switzerland.
- Department of Psychiatry and Addictology, Montreal University, Montreal, Canada.
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Hajizadeh A, Howes S, Theodoulou A, Klemperer E, Hartmann-Boyce J, Livingstone-Banks J, Lindson N. Antidepressants for smoking cessation. Cochrane Database Syst Rev 2023; 5:CD000031. [PMID: 37230961 PMCID: PMC10207863 DOI: 10.1002/14651858.cd000031.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The pharmacological profiles and mechanisms of antidepressants are varied. However, there are common reasons why they might help people to stop smoking tobacco: nicotine withdrawal can produce short-term low mood that antidepressants may relieve; and some antidepressants may have a specific effect on neural pathways or receptors that underlie nicotine addiction. OBJECTIVES To assess the evidence for the efficacy, harms, and tolerability of medications with antidepressant properties in assisting long-term tobacco smoking cessation in people who smoke cigarettes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, most recently on 29 April 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) in people who smoked, comparing antidepressant medications with placebo or no pharmacological treatment, an alternative pharmacotherapy, or the same medication used differently. We excluded trials with fewer than six months of follow-up from efficacy analyses. We included trials with any follow-up length for our analyses of harms. DATA COLLECTION AND ANALYSIS We extracted data and assessed risk of bias using standard Cochrane methods. Our primary outcome measure was smoking cessation after at least six months' follow-up. We used the most rigorous definition of abstinence available in each trial, and biochemically validated rates if available. Our secondary outcomes were harms and tolerance outcomes, including adverse events (AEs), serious adverse events (SAEs), psychiatric AEs, seizures, overdoses, suicide attempts, death by suicide, all-cause mortality, and trial dropouts due to treatment. We carried out meta-analyses where appropriate. MAIN RESULTS We included a total of 124 studies (48,832 participants) in this review, with 10 new studies added to this update version. Most studies recruited adults from the community or from smoking cessation clinics; four studies focused on adolescents (with participants between 12 and 21 years old). We judged 34 studies to be at high risk of bias; however, restricting analyses only to studies at low or unclear risk of bias did not change clinical interpretation of the results. There was high-certainty evidence that bupropion increased smoking cessation rates when compared to placebo or no pharmacological treatment (RR 1.60, 95% CI 1.49 to 1.72; I2 = 16%; 50 studies, 18,577 participants). There was moderate-certainty evidence that a combination of bupropion and varenicline may have resulted in superior quit rates to varenicline alone (RR 1.21, 95% CI 0.95 to 1.55; I2 = 15%; 3 studies, 1057 participants). However, there was insufficient evidence to establish whether a combination of bupropion and nicotine replacement therapy (NRT) resulted in superior quit rates to NRT alone (RR 1.17, 95% CI 0.95 to 1.44; I2 = 43%; 15 studies, 4117 participants; low-certainty evidence). There was moderate-certainty evidence that participants taking bupropion were more likely to report SAEs than those taking placebo or no pharmacological treatment. However, results were imprecise and the CI also encompassed no difference (RR 1.16, 95% CI 0.90 to 1.48; I2 = 0%; 23 studies, 10,958 participants). Results were also imprecise when comparing SAEs between people randomised to a combination of bupropion and NRT versus NRT alone (RR 1.52, 95% CI 0.26 to 8.89; I2 = 0%; 4 studies, 657 participants) and randomised to bupropion plus varenicline versus varenicline alone (RR 1.23, 95% CI 0.63 to 2.42; I2 = 0%; 5 studies, 1268 participants). In both cases, we judged evidence to be of low certainty. There was high-certainty evidence that bupropion resulted in more trial dropouts due to AEs than placebo or no pharmacological treatment (RR 1.44, 95% CI 1.27 to 1.65; I2 = 2%; 25 studies, 12,346 participants). However, there was insufficient evidence that bupropion combined with NRT versus NRT alone (RR 1.67, 95% CI 0.95 to 2.92; I2 = 0%; 3 studies, 737 participants) or bupropion combined with varenicline versus varenicline alone (RR 0.80, 95% CI 0.45 to 1.45; I2 = 0%; 4 studies, 1230 participants) had an impact on the number of dropouts due to treatment. In both cases, imprecision was substantial (we judged the evidence to be of low certainty for both comparisons). Bupropion resulted in inferior smoking cessation rates to varenicline (RR 0.73, 95% CI 0.67 to 0.80; I2 = 0%; 9 studies, 7564 participants), and to combination NRT (RR 0.74, 95% CI 0.55 to 0.98; I2 = 0%; 2 studies; 720 participants). However, there was no clear evidence of a difference in efficacy between bupropion and single-form NRT (RR 1.03, 95% CI 0.93 to 1.13; I2 = 0%; 10 studies, 7613 participants). We also found evidence that nortriptyline aided smoking cessation when compared with placebo (RR 2.03, 95% CI 1.48 to 2.78; I2 = 16%; 6 studies, 975 participants), and some evidence that bupropion resulted in superior quit rates to nortriptyline (RR 1.30, 95% CI 0.93 to 1.82; I2 = 0%; 3 studies, 417 participants), although this result was subject to imprecision. Findings were sparse and inconsistent as to whether antidepressants, primarily bupropion and nortriptyline, had a particular benefit for people with current or previous depression. AUTHORS' CONCLUSIONS There is high-certainty evidence that bupropion can aid long-term smoking cessation. However, bupropion may increase SAEs (moderate-certainty evidence when compared to placebo/no pharmacological treatment). There is high-certainty evidence that people taking bupropion are more likely to discontinue treatment compared with people receiving placebo or no pharmacological treatment. Nortriptyline also appears to have a beneficial effect on smoking quit rates relative to placebo, although bupropion may be more effective. Evidence also suggests that bupropion may be as successful as single-form NRT in helping people to quit smoking, but less effective than combination NRT and varenicline. In most cases, a paucity of data made it difficult to draw conclusions regarding harms and tolerability. Further studies investigating the efficacy of bupropion versus placebo are unlikely to change our interpretation of the effect, providing no clear justification for pursuing bupropion for smoking cessation over other licensed smoking cessation treatments; namely, NRT and varenicline. However, it is important that future studies of antidepressants for smoking cessation measure and report on harms and tolerability.
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Affiliation(s)
- Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seth Howes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elias Klemperer
- Departments of Psychological Sciences & Psychiatry, University of Vermont, Burlington, VT, USA
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Adkins-Hempel M, Japuntich SJ, Chrastek M, Dunsiger S, Breault CE, Ayenew W, Everson-Rose SA, Nijjar PS, Bock BC, Wu WC, Miedema MD, Carlson BM, Busch AM. Integrated smoking cessation and mood management following acute coronary syndrome: Protocol for the post-acute cardiac event smoking (PACES) trial. Addict Sci Clin Pract 2023; 18:29. [PMID: 37173792 PMCID: PMC10175930 DOI: 10.1186/s13722-023-00388-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Approximately 400,000 people who smoke cigarettes survive Acute Coronary Syndrome (ACS; unstable angina, ST and non-ST elevation myocardial infarction) each year in the US. Continued smoking following ACS is an independent predictor of mortality. Depressed mood post-ACS is also predictive of mortality, and smokers with depressed mood are less likely to abstain from smoking following an ACS. A single, integrated treatment targeting depressed mood and smoking could be effective in reducing post-ACS mortality. METHOD/DESIGN The overall aim of the current study is to conduct a fully powered efficacy trial enrolling 324 smokers with ACS and randomizing them to 12 weeks of an integrated smoking cessation and mood management treatment [Behavioral Activation Treatment for Cardiac Smokers (BAT-CS)] or control (smoking cessation and general health education). Both groups will be offered 8 weeks of the nicotine patch if medically cleared. Counseling in both arms will be provided by tobacco treatment specialists. Follow-up assessments will be conducted at end-of-treatment (12-weeks) and 6, 9, and 12 months after hospital discharge. We will track major adverse cardiac events and all-cause mortality for 36 months post-discharge. Primary outcomes are depressed mood and biochemically validated 7-day point prevalence abstinence from smoking over 12 months. DISCUSSION Results of this study will inform smoking cessation treatments post-ACS and provide unique data on the impact of depressed mood on success of post-ACS health behavior change attempts. TRIAL REGISTRATION ClinicalTrials.gov, NCT03413423. Registered 29 January 2018. https://beta. CLINICALTRIALS gov/study/NCT03413423 .
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Affiliation(s)
- Melissa Adkins-Hempel
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA
| | - Sandra J Japuntich
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA
- Division of Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, 900 S. 8th St., G5, Minneapolis, MN, 55415, USA
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 401 East River Parkway, Suite 131, Minneapolis, MN, 55455, USA
| | - Michelle Chrastek
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, School of Public Health, Brown University, 121 South Main St., Providence, RI, 02903, USA
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main St., Providence, RI, 02903, USA
| | - Christopher E Breault
- Center for Behavioral and Preventative Medicine, Lifespan, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
| | - Woubeshet Ayenew
- Division of Cardiology, Department of Medicine, Hennepin Healthcare, 900 South 8th St., O5, Minneapolis, MN, 55415, USA
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Susan A Everson-Rose
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 401 East River Parkway, Suite 131, Minneapolis, MN, 55455, USA
- Program in Health Disparities Research, University of Minnesota, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Beth C Bock
- Center for Behavioral and Preventative Medicine, Lifespan, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, 700 Butler Drive, Providence, RI, 02906, USA
| | - Wen-Chih Wu
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main St., Providence, RI, 02903, USA
- Center of Innovation in Long Term Services and Support, Providence VA Medical Center, 830 Chalkstone Ave., Providence, RI, 02908, USA
- Cardiovascular Rehab Center, Lifespan, 208 Collyer St., Providence, RI, 02904, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, 920 East 28th St., Suite 480, Minneapolis, MN, 55407, USA
| | - Brett M Carlson
- North Memorial Health Heart and Vascular Center, 3300 Oakdale Ave. N., Suite 200, Robbinsdale, MN, 55422, USA
| | - Andrew M Busch
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA.
- Division of Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, 900 S. 8th St., G5, Minneapolis, MN, 55415, USA.
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 401 East River Parkway, Suite 131, Minneapolis, MN, 55455, USA.
- Program in Health Disparities Research, University of Minnesota, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.
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Uikey MS, Dayal P. Association Between Comorbid Psychiatric Disorders and Persistent Smoking After a Diagnosis of Chronic Obstructive Pulmonary Disease Among Patients Seeking Treatment at a Tertiary Care Hospital in India. Cureus 2023; 15:e37688. [PMID: 37206529 PMCID: PMC10191065 DOI: 10.7759/cureus.37688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Smoking cessation is the most effective approach to slowing down the progression of chronic obstructive pulmonary disease (COPD). Despite this, almost half of COPD patients continue to smoke after diagnosis. COPD patients with current smoking status are more likely to have concurrent psychiatric comorbidities, for instance, depression and anxiety. These psychiatric disorders can contribute to the persistence of smoking in individuals with COPD. This study aimed to investigate predictors of smoking persistence in COPD patients. Materials and methods A cross-sectional study was conducted in the Outpatient Department (OPD) of the Department of Pulmonary Medicine in a tertiary care hospital from August 2018 to July 2019. Patients with COPD were screened for their smoking status. All subjects were then personally assessed for any psychiatric comorbidity using the Mini International Neuropsychiatric Interview (MINI), the Patient Health Questionnaire-9 (PHQ-9), and the Anxiety Inventory for Respiratory (AIR) Disease. Logistic regression was performed to compute the odds ratio (OR). Results The study included a total of 87 COPD patients. Of the 87 COPD patients, 50 were current smokers, and 37 were past smokers. COPD patients with psychiatric disorders were four times more likely to continue smoking than those without psychiatric comorbidities (OR: 4.62, 95% CI: 1.46-14.54). The results showed that increasing PHQ-9 scores by one unit in COPD patients increased the likelihood of continuing to smoke by 27 percent. Conclusion In our multivariate analysis, current depression was found as a significant predictor of continued smoking in COPD patients. The present results are consistent with reports from previous research that depressive symptoms are associated with continued smoking in patients with COPD. COPD patients who are currently smoking should be examined for psychiatric disorders and treated concurrently to achieve effective smoking cessation.
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Affiliation(s)
- Mahendra S Uikey
- Psychiatry, All India Institute of Medical Sciences, New Delhi, IND
| | - Prabhoo Dayal
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, IND
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Budenz A, Wiseman KP, Keefe B, Prutzman Y. User Engagement With Mood-Related Content on the National Cancer Institute Smokefree.Gov Initiative Cessation Resources. HEALTH EDUCATION & BEHAVIOR 2022; 49:613-617. [PMID: 35112581 PMCID: PMC9807027 DOI: 10.1177/10901981211073736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIMS This study aimed to examine engagement with mood-related content on the Smokefree.gov Initiative's smoking cessation resources. METHODS Smokefree.gov website analytics (July 2018-July 2019) were analyzed for user interactions with mood content on informational webpages and interactive self-assessment tools (mood quizzes, smoking quit plans). We also examined mood feature engagement (texting or pressing a command button for mood support) among text program and app users (July 2018-July 2019). RESULTS Mood webpage views comprised 1.5% of all Smokefree.gov webpage views. Depression quizzes represented 82.9% of quiz completions, and stress quizzes represented 0.4% of quiz completions. Stress, anxiety, and low mood were the most reported smoking triggers on quit plans. Approximately 7,000 text program users and 3,000 app users sought real-time mood support. CONCLUSIONS Given the importance of mood management in the smoking cessation process these findings demonstrate promising opportunities to increase the reach of mood support resources.
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Affiliation(s)
| | - Kara P. Wiseman
- University of Virginia School of Medicine, Charlottesville,
VA, USA
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10
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Taylor GMJ, Sawyer K, Kessler D, Munafò MR, Aveyard P, Shaw A. Views about integrating smoking cessation treatment within psychological services for patients with common mental illness: A multi-perspective qualitative study. Health Expect 2021; 24:411-420. [PMID: 33368996 PMCID: PMC8077097 DOI: 10.1111/hex.13182] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/09/2020] [Accepted: 11/17/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Tobacco smoking rates are significantly higher in people with common mental illness compared to those without. Smoking cessation treatment could be offered as part of usual outpatient psychological care, but currently is not. OBJECTIVE To understand patient and health care professionals' views about integrating smoking cessation treatment into outpatient psychological services for common mental illness. DESIGN Qualitative in-depth interviews, with thematic analysis. PARTICIPANTS Eleven Improving Access to Psychological Therapies (IAPT) psychological wellbeing practitioners (PWPs), six IAPT patients, and six stop smoking advisors were recruited from English smoking cessation, and IAPT services. RESULTS Patients reported psychological benefits from smoking, and also described smoking as a form of self-harm. Stop smoking advisors displayed therapeutic pessimism and stigmatizing attitudes towards helping people with mental illness to quit smoking. PWPs have positive attitudes towards smoking cessation treatment for people with common mental illness. PWPs and patients accept evidence that smoking tobacco may harm mental health, and quitting might benefit mental health. PWPs report expertise in helping people with common mental illness to make behavioural changes in the face of mood disturbances and low motivation. PWPs felt confident in offering smoking cessation treatments to patients, but suggested a caseload reduction may be required to deliver smoking cessation support in IAPT. CONCLUSIONS IAPT appears to be a natural environment for smoking cessation treatment. PWPs may need additional training, and a caseload reduction. Integration of smoking cessation treatment into IAPT services should be tested in a pilot and feasibility study. PATIENT OR PUBLIC CONTRIBUTION Service users and members of the public were involved in study design and interpretation of data.
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Affiliation(s)
- Gemma M. J. Taylor
- Addiction and Mental Health Group (AIM)Department of PsychologyUniversity of BathBathUK
| | - Katherine Sawyer
- Addiction and Mental Health Group (AIM)Department of PsychologyUniversity of BathBathUK
| | - David Kessler
- Centre for Academic Primary CareBristol Medical SchoolUniversity of BristolBristolUK
| | - Marcus R. Munafò
- MRC Integrative Epidemiology UnitSchool of Psychological ScienceUniversity of BristolBristolUK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Alison Shaw
- Centre for Academic Primary CareBristol Medical SchoolUniversity of BristolBristolUK
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11
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Bezerra HDS, Alves RM, de Souza TA, Medeiros ADA, Barbosa IR. Factors Associated With Mental Suffering in the Brazilian Population: A Multilevel Analysis. Front Psychol 2021; 12:625191. [PMID: 33841256 PMCID: PMC8026874 DOI: 10.3389/fpsyg.2021.625191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/26/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To analyze how individual characteristics and the social context are associated with mental distress symptoms in the Brazilian population. Method: A multilevel cross-sectional study with data from the 2013 National Health Survey. There were two dependent variables: (a) decreased vital energy and somatic symptoms, (b) the presence of depressive thoughts. The independent variables were biological characteristics, education and income, habits and lifestyle, and context variables. Bivariate analysis was performed, and Prevalence Ratios calculated in a Poisson Regression (95% CI). A multilevel Poisson Regression was performed to verify the effect of individual and contextual variables. Results: Regarding depressive thoughts, young and middle-aged individuals, low education, women, absence of partner, smokers or former smokers, and absence of health insurance were the categories at highest risk; belonging to classes D-E and living in states with lower expected years of schooling proved to be protective factors. Similar results were found for the second outcome. Conclusions: Symptoms of mental distress were associated with the individual characteristics and contextual aspects of the federation unit. These findings indicate the importance of strengthening psychosocial care aimed at vulnerable groups.
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Affiliation(s)
| | - Roberta Machado Alves
- Graduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Talita Araujo de Souza
- Graduate Program of Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Arthur de Almeida Medeiros
- Graduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil.,Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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12
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Minian N, Ahad S, Ivanova A, Veldhuizen S, Zawertailo L, Ravindran A, de Oliveira C, Baliunas D, Mulder C, Bolbocean C, Selby P. The effectiveness of generic emails versus a remote knowledge broker to integrate mood management into a smoking cessation programme in team-based primary care: a cluster randomised trial. Implement Sci 2021; 16:30. [PMID: 33743777 PMCID: PMC7980670 DOI: 10.1186/s13012-021-01091-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Knowledge brokering is a knowledge translation approach that has been gaining popularity in Canada although the effectiveness is unknown. This study evaluated the effectiveness of generalised, exclusively email-based prompts versus a personalised remote knowledge broker for delivering evidence-based mood management interventions within an existing smoking cessation programme in primary care settings. METHODS The study design is a cluster randomised controlled trial of 123 Ontario Family Health Teams participating in the Smoking Treatment for Ontario Patients programme. They were randomly allocated 1:1 for healthcare providers to receive either: a remote knowledge broker offering tailored support via phone and email (group A), or a generalised monthly email focused on tobacco and depression treatment (group B), to encourage the implementation of an evidence-based mood management intervention to smokers presenting depressive symptoms. The primary outcome was participants' acceptance of a self-help mood management resource. The secondary outcome was smoking abstinence at 6-month follow-up, measured by self-report of smoking abstinence for at least 7 previous days. The tertiary outcome was the costs of delivering each intervention arm, which, together with the effectiveness outcomes, were used to undertake a cost minimisation analysis. RESULTS Between February 2018 and January 2019, 7175 smokers were screened for depression and 2765 (39%) reported current/past depression. Among those who reported current/past depression, 29% (437/1486) and 27% (345/1277) of patients accepted the mood management resource in group A and group B, respectively. The adjusted generalised estimating equations showed that there was no significant difference between the two treatment groups in patients' odds of accepting the mood management resource or in the patients' odds of smoking abstinence at follow-up. The cost minimisation analysis showed that the email strategy was the least costly option. CONCLUSIONS Most participants did not accept the resource regardless of remote knowledge broker strategy. In contexts with an existing KT infrastructure, decision-makers should consider an email strategy when making changes to a programme given its lower cost compared with other strategies. More research is required to improve remote knowledge broker strategies. TRIAL REGISTRATION ClinicalTrials.gov, NCT03130998 . Registered April 18, 2017, (Archived on WebCite at www.webcitation.org/6ylyS6RTe ).
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Affiliation(s)
- Nadia Minian
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., 1st floor, Toronto, ON, M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, 1 King's College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
| | - Sheleza Ahad
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Anna Ivanova
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Scott Veldhuizen
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., 1st floor, Toronto, ON, M5T 1R8, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Medical Sciences Building, Room 4207, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Arun Ravindran
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M5T 1P7, Canada
- Department of Psychiatry, University of Toronto, 250 College Street 8th floor, Toronto, ON, M5T 1R8, Canada
| | - Claire de Oliveira
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Suite 425, Toronto, ON, M5T 3M6, Canada
- Centre for Health Economics and Hull York Medical School, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK
| | - Dolly Baliunas
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| | - Carol Mulder
- Queen's University Department of Family Medicine, 220 Bagot St, Kingston, ON, K7L 3G2, Canada
| | - Corneliu Bolbocean
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline Street, Suite 633, Memphis, TN, 3816, USA
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada.
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., 1st floor, Toronto, ON, M5T 1R8, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street 8th floor, Toronto, ON, M5T 1R8, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada.
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13
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Minian N, Lingam M, deRuiter WK, Dragonetti R, Selby P. Co-designing Behavior Change Resources With Treatment-Seeking Smokers: Engagement Events' Findings. Front Public Health 2021; 9:555449. [PMID: 33791263 PMCID: PMC8005552 DOI: 10.3389/fpubh.2021.555449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 02/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Primary care organizations are well-suited to help patients change their unhealthy behaviors. Evidence shows that risk communication and self-monitoring of behavior are is an effective strategy practitioners can use to promote health behavior change with their patients. In order for this evidence to be actionable, it is important to understand how patients would like this information to be communicated and to operationalize the self-monitoring resources. The objective of this study was to co-create resources that encourage behavior change based on the scientific evidence and from patients with lived experiences. Materials and Methods: Twenty-seven individuals who participated in a smoking cessation program and engaged in at least one other unhealthy behavior joined one of two engagement events. Each event was 3 h in duration and consisted of two exercises that provided support to participants in reaching a consensus about the types of messages they would like to receive from their practitioner as well as self-monitoring resources they would prefer to use. The first exercise followed an adapted version of the Consensus Methodology developed by the Institute of Cultural Affairs Canada, while the second exercise was in accordance to the Nominal Group Technique. Results: Participants' preference was to have practitioners convey messages to promote health behavior change that include positive affirmation and to monitor all their health behaviors using a single self-reported tracking sheet. Conclusions: This paper features the use of engagement events to reflect upon and identify potential resources that treatment seeking smokers prefer to receive while attempting to modify unhealthy behaviors. These resources can be used by health care providers in primary care settings to support health promotion interventions and assist their patients to increase their likelihood of adopting positive changes to risk behaviors.
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Affiliation(s)
- Nadia Minian
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mathangee Lingam
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wayne K deRuiter
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosa Dragonetti
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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14
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Taylor GM, Baker AL, Fox N, Kessler DS, Aveyard P, Munafò MR. Addressing concerns about smoking cessation and mental health: theoretical review and practical guide for healthcare professionals. BJPSYCH ADVANCES 2021; 27:85-95. [PMID: 34513007 PMCID: PMC7611646 DOI: 10.1192/bja.2020.52] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Smoking rates in people with depression and anxiety are twice as high as in the general population, even though people with depression and anxiety are motivated to stop smoking. Most healthcare professionals are aware that stopping smoking is one of the greatest changes that people can make to improve their health. However, smoking cessation can be a difficult topic to raise. Evidence suggests that smoking may cause some mental health problems, and that the tobacco withdrawal cycle partly contributes to worse mental health. By stopping smoking, a person's mental health may improve, and the size of this improvement might be equal to taking anti-depressants. In this theoretical review and practical guide we outline ways in which healthcare professionals can raise the topic of smoking compassionately and respectfully to encourage smoking cessation. We draw on evidence-based methods like cognitive behavioural therapy, and outline approaches that healthcare professionals can use to integrate these methods into routine care.
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Affiliation(s)
- Gemma M.J. Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | - Amanda L. Baker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2298, Australia
| | - Nadine Fox
- Talking Space Plus, Oxford Health NHS Foundation Trust, Oxford, OX3 7JH, UK
| | - David S. Kessler
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, BS8 2BN, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Oxford, OX2 6GG, UK
| | - Marcus R. Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, BS8 1TU, UK
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15
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Hartmann-Boyce J, Livingstone-Banks J, Ordóñez-Mena JM, Fanshawe TR, Lindson N, Freeman SC, Sutton AJ, Theodoulou A, Aveyard P. Behavioural interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2021; 1:CD013229. [PMID: 33411338 DOI: 10.1002/14651858.cd013229.pub2] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Smoking is a leading cause of disease and death worldwide. In people who smoke, quitting smoking can reverse much of the damage. Many people use behavioural interventions to help them quit smoking; these interventions can vary substantially in their content and effectiveness. OBJECTIVES To summarise the evidence from Cochrane Reviews that assessed the effect of behavioural interventions designed to support smoking cessation attempts and to conduct a network meta-analysis to determine how modes of delivery; person delivering the intervention; and the nature, focus, and intensity of behavioural interventions for smoking cessation influence the likelihood of achieving abstinence six months after attempting to stop smoking; and whether the effects of behavioural interventions depend upon other characteristics, including population, setting, and the provision of pharmacotherapy. To summarise the availability and principal findings of economic evaluations of behavioural interventions for smoking cessation, in terms of comparative costs and cost-effectiveness, in the form of a brief economic commentary. METHODS This work comprises two main elements. 1. We conducted a Cochrane Overview of reviews following standard Cochrane methods. We identified Cochrane Reviews of behavioural interventions (including all non-pharmacological interventions, e.g. counselling, exercise, hypnotherapy, self-help materials) for smoking cessation by searching the Cochrane Library in July 2020. We evaluated the methodological quality of reviews using AMSTAR 2 and synthesised data from the reviews narratively. 2. We used the included reviews to identify randomised controlled trials of behavioural interventions for smoking cessation compared with other behavioural interventions or no intervention for smoking cessation. To be included, studies had to include adult smokers and measure smoking abstinence at six months or longer. Screening, data extraction, and risk of bias assessment followed standard Cochrane methods. We synthesised data using Bayesian component network meta-analysis (CNMA), examining the effects of 38 different components compared to minimal intervention. Components included behavioural and motivational elements, intervention providers, delivery modes, nature, focus, and intensity of the behavioural intervention. We used component network meta-regression (CNMR) to evaluate the influence of population characteristics, provision of pharmacotherapy, and intervention intensity on the component effects. We evaluated certainty of the evidence using GRADE domains. We assumed an additive effect for individual components. MAIN RESULTS We included 33 Cochrane Reviews, from which 312 randomised controlled trials, representing 250,563 participants and 845 distinct study arms, met the criteria for inclusion in our component network meta-analysis. This represented 437 different combinations of components. Of the 33 reviews, confidence in review findings was high in four reviews and moderate in nine reviews, as measured by the AMSTAR 2 critical appraisal tool. The remaining 20 reviews were low or critically low due to one or more critical weaknesses, most commonly inadequate investigation or discussion (or both) of the impact of publication bias. Of note, the critical weaknesses identified did not affect the searching, screening, or data extraction elements of the review process, which have direct bearing on our CNMA. Of the included studies, 125/312 were at low risk of bias overall, 50 were at high risk of bias, and the remainder were at unclear risk. Analyses from the contributing reviews and from our CNMA showed behavioural interventions for smoking cessation can increase quit rates, but effectiveness varies on characteristics of the support provided. There was high-certainty evidence of benefit for the provision of counselling (odds ratio (OR) 1.44, 95% credibility interval (CrI) 1.22 to 1.70, 194 studies, n = 72,273) and guaranteed financial incentives (OR 1.46, 95% CrI 1.15 to 1.85, 19 studies, n = 8877). Evidence of benefit remained when removing studies at high risk of bias. These findings were consistent with pair-wise meta-analyses from contributing reviews. There was moderate-certainty evidence of benefit for interventions delivered via text message (downgraded due to unexplained statistical heterogeneity in pair-wise comparison), and for the following components where point estimates suggested benefit but CrIs incorporated no clinically significant difference: individual tailoring; intervention content including motivational components; intervention content focused on how to quit. The remaining intervention components had low-to very low-certainty evidence, with the main issues being imprecision and risk of bias. There was no evidence to suggest an increase in harms in groups receiving behavioural support for smoking cessation. Intervention effects were not changed by adjusting for population characteristics, but data were limited. Increasing intensity of behavioural support, as measured through the number of contacts, duration of each contact, and programme length, had point estimates associated with modestly increased chances of quitting, but CrIs included no difference. The effect of behavioural support for smoking cessation appeared slightly less pronounced when people were already receiving smoking cessation pharmacotherapies. AUTHORS' CONCLUSIONS Behavioural support for smoking cessation can increase quit rates at six months or longer, with no evidence that support increases harms. This is the case whether or not smoking cessation pharmacotherapy is also provided, but the effect is slightly more pronounced in the absence of pharmacotherapy. Evidence of benefit is strongest for the provision of any form of counselling, and guaranteed financial incentives. Evidence suggested possible benefit but the need of further studies to evaluate: individual tailoring; delivery via text message, email, and audio recording; delivery by lay health advisor; and intervention content with motivational components and a focus on how to quit. We identified 23 economic evaluations; evidence did not consistently suggest one type of behavioural intervention for smoking cessation was more cost-effective than another. Future reviews should fully consider publication bias. Tools to investigate publication bias and to evaluate certainty in CNMA are needed.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Suzanne C Freeman
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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16
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Hall CL, Sanderson C, Brown BJ, Andrén P, Bennett S, Chamberlain LR, Davies EB, Khan K, Kouzoupi N, Mataix-Cols D, McKenzie C, Murphy T, Townsend M, Hollis C, Murray E. Opportunities and challenges of delivering digital clinical trials: lessons learned from a randomised controlled trial of an online behavioural intervention for children and young people. Trials 2020; 21:1011. [PMID: 33298127 PMCID: PMC7724811 DOI: 10.1186/s13063-020-04902-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/15/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite being the gold standard of research to determine effectiveness, randomised controlled trials (RCTs) often struggle with participant recruitment, engagement and retention. These issues may be exacerbated when recruiting vulnerable populations, such as participants with mental health issues. We aimed to update understanding of the scope of these problems in trials of health technology and identify possible solutions through reflecting on experiences from an exemplar trial (Online Remote Behavioural Intervention for Tics; ORBIT). METHOD We extracted anonymised data on recruitment, retention and requests for more funding and time from trials funded by the largest funder of health technology trials in the UK (the National Institute of Health Research Health Technology Assessment) between 2010 and 2020, and compared these with data from a recent, successful trial (ORBIT). ORBIT aimed to assess the clinical- and cost-effectiveness of blended online and human behavioural therapy for tics in young people. Many of the trial procedures, including recruitment, the intervention and data collection, were undertaken online. RESULTS Data were extracted on 51 trials conducted between 2010 and 2020. Sixty per cent of trials failed to reach their original recruitment target and only 44% achieved their follow-up in the specified time frame. In contrast, ORBIT recruited to target and achieved 90% follow-up. We posit that these achievements are related to (a) judicious use of digital technology for trial procedures and (b) adequate numbers of highly trained and motivated trial staff. We provide details of both these to help other research teams plan and cost for successful trials. CONCLUSION An approach combining human and online methods may be advantageous in facilitating trial delivery, particularly in paediatric mental health services. Given the importance of successful clinical trials in advancing healthcare delivery and the waste of human and economic resources associated with unsuccessfully delivered trials, it is imperative that trials are appropriately costed and future research focusses on improving trial design and delivery. TRIAL REGISTRATION The ORBIT trial is registered with ISRTCN ( ISRCTN70758207 ) Registered on March 20, 2018. and ClinicalTrials.gov ( NCT03483493 ). Registered on March 30, 2018.
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Affiliation(s)
- Charlotte L. Hall
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Charlotte Sanderson
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Beverly J. Brown
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sophie Bennett
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Liam R. Chamberlain
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - E. Bethan Davies
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Kareem Khan
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Natalie Kouzoupi
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Caitlin McKenzie
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Tara Murphy
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Mark Townsend
- National Institute for Health Research, University of Southampton, Alpha House, Enterprise Road, Southampton, UK
| | - Chris Hollis
- NIHR MindTech Medtech Co-operative, School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
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17
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Carroll AJ, Mathew AR, Leone FT, Wileyto EP, Miele A, Schnoll RA, Hitsman B. Extended Nicotine Patch Treatment Among Smokers With and Without Comorbid Psychopathology. Nicotine Tob Res 2020; 22:24-31. [PMID: 30215785 DOI: 10.1093/ntr/nty191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/08/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Individuals with psychiatric conditions smoke at higher rates than the general population and may need more intensive treatment to quit. We examined whether or not extended treatment with nicotine patch, combined with behavior counseling, would disproportionally benefit smokers with versus without a lifetime psychiatric condition. METHODS We conducted a secondary analysis of data from an effectiveness trial of treatment with 12 counseling sessions (48 weeks) and 21-mg nicotine patch (8, 24, or 52 weeks) among 525 adult daily smokers. A structured clinical interview assessed past and current psychiatric disorders (major depression, generalized anxiety disorder, alcohol abuse and/or dependence, and substance abuse and/or dependence), as described in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Abstinence was bioverified at week 52. Logistic regression evaluated the effect of the psychiatric status × treatment duration interaction on abstinence at week 52, covarying for sociodemographics, baseline psychological symptoms, and treatment adherence. RESULTS At baseline, 115 (21.9%) participants were diagnosed with one or more psychiatric conditions. The psychiatric status × treatment duration interaction was significant for week 52 abstinence (p = .027). Abstinence rates between smokers with versus without a psychiatric condition in the 24-week treatment arm (9.3% vs. 31.5% abstinent) significantly differed from the 8-week treatment arm (18.8% vs. 22.3%), p = .017. Abstinence rates for smokers with (22.5%) versus without a psychiatric condition (19.7%) in the 52-week treatment arm did not differ from those in the 8-week arm. CONCLUSIONS Targeted smoking cessation treatment, rather than extending treatment duration, may be especially warranted to optimize treatment for smokers with comorbid mood, anxiety, and substance use disorders. IMPLICATIONS Individuals with psychiatric conditions smoke at higher rates and have greater difficulty quitting compared to those in the general population, but little is known about how to best optimize treatment for this high tobacco burden population. The present study found that cessation response to extended duration treatment with the transdermal nicotine patch did not differ for smokers with versus without comorbid anxiety, mood, and substance use disorders in a large-scale clinical effectiveness trial. Development of targeted behavioral treatments may be required to optimize abstinence outcomes for this high-risk population, rather than simply extending the duration of pharmacotherapy treatments.
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Affiliation(s)
- Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amanda R Mathew
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Frank T Leone
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew Miele
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert A Schnoll
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Sheffer CE, Stein JS, Petrucci C, Mahoney MC, Johnson S, Giesie P, Carl E, Krupski L, Tegge AN, Reid ME, Bickel WK, Hyland A. Tobacco Dependence Treatment in Oncology: Initial Patient Clinical Characteristics and Outcomes from Roswell Park Comprehensive Cancer Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3907. [PMID: 32486463 PMCID: PMC7312979 DOI: 10.3390/ijerph17113907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 01/28/2023]
Abstract
Despite the importance of smoking cessation to cancer care treatment, historically, few cancer centers have provided treatment for tobacco dependence. To address this gap, the National Cancer Institute (NCI) launched the Cancer Center Cessation Initiative (C3i). As part of this effort, this study examined implementation outcomes in a cohort of cancer survivors (CSs) who smoked cigarettes in the first year of an ongoing process to develop and implement a robust Tobacco Treatment Service at Roswell Park Comprehensive Cancer Center. We provide a comprehensive description of the new tobacco use assessment and referral process, and of the characteristics of cancer survivors who agreed to treatment including traditional tobacco-related psychosocial and cancer treatment-related characteristics and novel characteristics such as delay discounting rates. We also examine characteristic differences among those who agreed to treatment between those who attended and those who did not attend treatment. As the new tobacco assessment was implemented, the number of referrals increased dramatically. The mean number of treatment sessions attended was 4.45 (SD = 2.98) and the six-month point prevalence intention to treat abstinence rate among those who attended was 22.7%. However, only 6.4% agreed to treatment and 4% attended at least one treatment session. A large proportion of cancer survivors who agreed to treatment were women, of older age, of lower socioeconomic status (SES), and who had high levels of depressive symptomology. The findings demonstrate that the implementation of system changes can significantly improve the identification of cancer survivors who use tobacco and are referred to tobacco use treatment. Among those who attend, treatment is effective. However, the findings also suggest that a systematic assessment of barriers to engagement is needed and that cancer survivors may benefit from additional treatment tailoring. We present plans to address these implementation challenges. Systematic electronic medical record (EMR)-sourced referral to tobacco treatment is a powerful tool for reaching cancer survivors who smoke, but more research is needed to determine how to enhance engagement and tailor treatment processes.
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Affiliation(s)
- Christine E. Sheffer
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Jeffrey S. Stein
- Fralin Biomedical Research Institute at VTC, Roanoke, VA 24016, USA; (J.S.S.); (A.N.T.); (W.K.B.)
| | - Cara Petrucci
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Martin C. Mahoney
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Shirley Johnson
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Pamela Giesie
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Ellen Carl
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Laurie Krupski
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Allison N. Tegge
- Fralin Biomedical Research Institute at VTC, Roanoke, VA 24016, USA; (J.S.S.); (A.N.T.); (W.K.B.)
| | - Mary E. Reid
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
| | - Warren K. Bickel
- Fralin Biomedical Research Institute at VTC, Roanoke, VA 24016, USA; (J.S.S.); (A.N.T.); (W.K.B.)
| | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (C.P.); (M.C.M.); (S.J.); (P.G.); (E.C.); (L.K.); (M.E.R.); (A.H.)
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Abstract
BACKGROUND Whilst the pharmacological profiles and mechanisms of antidepressants are varied, there are common reasons why they might help people to stop smoking tobacco. Firstly, nicotine withdrawal may produce depressive symptoms and antidepressants may relieve these. Additionally, some antidepressants may have a specific effect on neural pathways or receptors that underlie nicotine addiction. OBJECTIVES To assess the evidence for the efficacy, safety and tolerability of medications with antidepressant properties in assisting long-term tobacco smoking cessation in people who smoke cigarettes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Specialized Register, which includes reports of trials indexed in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO, clinicaltrials.gov, the ICTRP, and other reviews and meeting abstracts, in May 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs) that recruited smokers, and compared antidepressant medications with placebo or no treatment, an alternative pharmacotherapy, or the same medication used in a different way. We excluded trials with less than six months follow-up from efficacy analyses. We included trials with any follow-up length in safety analyses. DATA COLLECTION AND ANALYSIS We extracted data and assessed risk of bias using standard Cochrane methods. We also used GRADE to assess the certainty of the evidence. The primary outcome measure was smoking cessation after at least six months follow-up, expressed as a risk ratio (RR) and 95% confidence intervals (CIs). We used the most rigorous definition of abstinence available in each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed-effect model. Similarly, we presented incidence of safety and tolerance outcomes, including adverse events (AEs), serious adverse events (SAEs), psychiatric AEs, seizures, overdoses, suicide attempts, death by suicide, all-cause mortality, and trial dropout due to drug, as RRs (95% CIs). MAIN RESULTS We included 115 studies (33 new to this update) in this review; most recruited adult participants from the community or from smoking cessation clinics. We judged 28 of the studies to be at high risk of bias; however, restricting analyses only to studies at low or unclear risk did not change clinical interpretation of the results. There was high-certainty evidence that bupropion increased long-term smoking cessation rates (RR 1.64, 95% CI 1.52 to 1.77; I2 = 15%; 45 studies, 17,866 participants). There was insufficient evidence to establish whether participants taking bupropion were more likely to report SAEs compared to those taking placebo. Results were imprecise and CIs encompassed no difference (RR 1.16, 95% CI 0.90 to 1.48; I2 = 0%; 21 studies, 10,625 participants; moderate-certainty evidence, downgraded one level due to imprecision). We found high-certainty evidence that use of bupropion resulted in more trial dropouts due to adverse events of the drug than placebo (RR 1.37, 95% CI 1.21 to 1.56; I2 = 19%; 25 studies, 12,340 participants). Participants randomized to bupropion were also more likely to report psychiatric AEs compared with those randomized to placebo (RR 1.25, 95% CI 1.15 to 1.37; I2 = 15%; 6 studies, 4439 participants). We also looked at the safety and efficacy of bupropion when combined with other non-antidepressant smoking cessation therapies. There was insufficient evidence to establish whether combination bupropion and nicotine replacement therapy (NRT) resulted in superior quit rates to NRT alone (RR 1.19, 95% CI 0.94 to 1.51; I2 = 52%; 12 studies, 3487 participants), or whether combination bupropion and varenicline resulted in superior quit rates to varenicline alone (RR 1.21, 95% CI 0.95 to 1.55; I2 = 15%; 3 studies, 1057 participants). We judged the certainty of evidence to be low and moderate, respectively; in both cases due to imprecision, and also due to inconsistency in the former. Safety data were sparse for these comparisons, making it difficult to draw clear conclusions. A meta-analysis of six studies provided evidence that bupropion resulted in inferior smoking cessation rates to varenicline (RR 0.71, 95% CI 0.64 to 0.79; I2 = 0%; 6 studies, 6286 participants), whilst there was no evidence of a difference in efficacy between bupropion and NRT (RR 0.99, 95% CI 0.91 to 1.09; I2 = 18%; 10 studies, 8230 participants). We also found some evidence that nortriptyline aided smoking cessation when compared with placebo (RR 2.03, 95% CI 1.48 to 2.78; I2 = 16%; 6 studies, 975 participants), whilst there was insufficient evidence to determine whether bupropion or nortriptyline were more effective when compared with one another (RR 1.30 (favouring bupropion), 95% CI 0.93 to 1.82; I2 = 0%; 3 studies, 417 participants). There was no evidence that any of the other antidepressants tested (including St John's Wort, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs)) had a beneficial effect on smoking cessation. Findings were sparse and inconsistent as to whether antidepressants, primarily bupropion and nortriptyline, had a particular benefit for people with current or previous depression. AUTHORS' CONCLUSIONS There is high-certainty evidence that bupropion can aid long-term smoking cessation. However, bupropion also increases the number of adverse events, including psychiatric AEs, and there is high-certainty evidence that people taking bupropion are more likely to discontinue treatment compared with placebo. However, there is no clear evidence to suggest whether people taking bupropion experience more or fewer SAEs than those taking placebo (moderate certainty). Nortriptyline also appears to have a beneficial effect on smoking quit rates relative to placebo. Evidence suggests that bupropion may be as successful as NRT and nortriptyline in helping people to quit smoking, but that it is less effective than varenicline. There is insufficient evidence to determine whether the other antidepressants tested, such as SSRIs, aid smoking cessation, and when looking at safety and tolerance outcomes, in most cases, paucity of data made it difficult to draw conclusions. Due to the high-certainty evidence, further studies investigating the efficacy of bupropion versus placebo are unlikely to change our interpretation of the effect, providing no clear justification for pursuing bupropion for smoking cessation over front-line smoking cessation aids already available. However, it is important that where studies of antidepressants for smoking cessation are carried out they measure and report safety and tolerability clearly.
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Affiliation(s)
- Seth Howes
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Jamie Hartmann-Boyce
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | | | - Bosun Hong
- Birmingham Dental Hospital, Oral Surgery Department, 5 Mill Pool Way, Birmingham, UK, B5 7EG
| | - Nicola Lindson
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
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Secades-Villa R, González-Roz A, Vallejo-Seco G, Weidberg S, García-Pérez Á, Alonso-Pérez F. Additive effectiveness of contingency management on cognitive behavioural treatment for smokers with depression: Six-month abstinence and depression outcomes. Drug Alcohol Depend 2019; 204:107495. [PMID: 31491583 DOI: 10.1016/j.drugalcdep.2019.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Depression and smoking co-occur at high rates and there is a lack of evidence on the efficacy of treatments specifically tailored to this population. This randomized controlled trial sought to compare the effectiveness of cognitive behavioural treatment (CBT) combined with behavioural activation (BA) and the same treatment protocol plus contingency management (CM). METHODS A sample of 120 adult smokers (70.8%: females) with severe depressive symptoms were randomly allocated to: CBT + BA (n = 60) or CBT + BA + CM (n = 60). Smoking and depression outcomes were reported at end of treatment, 1-, 2-, 3-, and 6-month follow-ups. Self-reported smoking status was biochemically verified, and depression was assessed using the Beck Depression Inventory-II. RESULTS At end of treatment, the overall quit rate was 69.2% (83/120). CM showed an additive effect on CBT + BA in enhancing abstinence rates. The significant effect of group [F(1,155) = 9.55, p = .0024], time [F(4,96) = 7.93, p < .0001], and group by time interaction [F(4,96) = 6.12, p = .0002], indicated that CM is more effective for generating longer durations of abstinence beyond those of CBT+BA. All treatment conditions equally promoted sustained reductions in depression across time [F(1,111) = 0.53, p = .4665]. A greater number of days of continuous abstinence and lower depressive symptoms mutually influenced each other. CONCLUSIONS Depressed smokers achieve high cessation rates without suffering negative mood changes. Quitting smoking is not detrimental and adding CM to CBT + BA enhances long-lasting abstinence rates while promoting large depression improvements.
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Affiliation(s)
- Roberto Secades-Villa
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | - Alba González-Roz
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain.
| | | | - Sara Weidberg
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | - Ángel García-Pérez
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | - Fernando Alonso-Pérez
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
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Metse AP, Stockings E, Bailey J, Regan T, Bartlem K, Wolfenden L, Taylor G, Wiggers J, Bowman J. Rates of retention of persons with a mental health disorder in outpatient smoking cessation and reduction trials, and associated factors: protocol for a systematic review and meta-analysis. BMJ Open 2019; 9:e030646. [PMID: 31488491 PMCID: PMC6731776 DOI: 10.1136/bmjopen-2019-030646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/20/2019] [Accepted: 07/31/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Smoking among persons with a mental health disorder is associated with inequitable health, social and economic burden. Randomised controlled trials (RCTs) are considered the gold standard design for the assessment of healthcare intervention efficacy/effectiveness. However, many RCTs of smoking interventions for persons with a mental health disorder lack rigour due to low participant retention. No systematic review has pooled retention rates in randomised trials of smoking interventions for persons with a mental health disorder or explored associated factors. The aims of the systematic review will therefore be to: (1) summarise overall rates of participant retention in smoking cessation and reduction trials involving persons with a mental health disorder (including for experimental and control groups separately) and (2) determine if retention rates vary according to participant, environmental, researcher and study factors. METHODS AND ANALYSIS PsycINFO, EMBASE, MEDLINE, CENTRAL and The Cochrane Tobacco Addiction Review Group Specialised Register will be searched for reports of RCTs of outpatient smoking cessation or reduction interventions for adults with a mental health disorder. The search terms will include MeSH terms and free text words, and there will be no language or date restrictions. All databases will be searched from inception to present. Data will be analysed using the Mantel-Haenszel fixed-effect model, and where substantial heterogeneity (I2 >50%) is detected, DerSimonian & Laird inverse-variance random effects model. Pooled estimates and 95% CIs will be calculated for overall participant retention rates and for intervention and control trial arms separately. Associations between participant retention and participant, environmental, researcher and study factors will be assessed via subgroup analyses and, where sufficient data are obtained, meta-regression. ETHICS AND DISSEMINATION This study does not require ethical approval. The findings of this review will be disseminated via publication in a peer-reviewed open access medical journal and presentations at international scientific meetings.
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Affiliation(s)
- Alexandra Patricia Metse
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- Discipline of Psychology, Murdoch University, Murdoch, Western Australia, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacqueline Bailey
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Timothy Regan
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kate Bartlem
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Gemma Taylor
- Department of Psychology, University of Bath, Bath, BA2 7AY, United Kingdom
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Jenny Bowman
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
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Rapid relapse to smoking following hospital discharge. Prev Med Rep 2019; 15:100891. [PMID: 31193919 PMCID: PMC6543250 DOI: 10.1016/j.pmedr.2019.100891] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/30/2019] [Accepted: 05/12/2019] [Indexed: 11/20/2022] Open
Abstract
Many of nearly 7 million smokers who are hospitalized each year plan to stay quit after they leave the hospital. Most, however, relapse after discharge. This is a secondary analysis of a large Midwestern hospital-based smoking cessation trial that occurred between July 2011 and May 2013 to better understand how quickly smokers relapse and the predictors of rapid relapse. Of 942 participants who completed follow up, 25% returned to smoking within a day after hospital discharge. Among these rapid relapses, 36.6% relapsed within one-hour of leaving the hospital, 35.3% between one and 24 h, and 28.1% relapsed one-day post-discharge. Predictors with the highest odds for rapid relapse (within a day of hospital discharge) included tobacco use during hospitalization (OR, 7.37, [95% CI, 3.85–14.13], P < 0.01); low confidence for quitting (OR, 2.07, [95% CI, 1.49–2.88], P < 0.01); and not setting a quit date (OR, 1.76, [95% CI, 1.25–2.48], P < 0.01). Other significant predictors included higher nicotine dependence, shorter length of stay, and depression. Patients who are vulnerable to rapid relapse may benefit from policies that discourage leaving the hospital to smoke. In addition, hospital interventions that target smokers' confidence in quitting, encourage setting a quit date, and addressing nicotine dependence and depression may also be effective at supporting smoker's intentions to make their pre-admission cigarette their last. Clinical Trials Registration NCT01305928
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23
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Martínez-Vispo C, Rodríguez-Cano R, López-Durán A, Senra C, Fernández del Río E, Becoña E. Cognitive-behavioral treatment with behavioral activation for smoking cessation: Randomized controlled trial. PLoS One 2019; 14:e0214252. [PMID: 30958831 PMCID: PMC6453447 DOI: 10.1371/journal.pone.0214252] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/07/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction Behavioral Activation is a behavioral-based treatment that has been proposed as suitable for smoking cessation, as it simultaneously addresses reinforcement-related variables and also mood management. The aim of this study was to compare the effects of a cognitive-behavioral smoking cessation treatment with components of behavioral activation (SCBSCT-BA) with a standard cognitive-behavioral treatment (SCBSCT), and a wait-list control group (WL). Method The sample was comprised of 275 adults smokers (61.4% females, mean age = 45.36, SD = 10.96). After baseline assessment sessions, participants were randomized (ratio: 2.2.1.) to SCBSCT-BA, SCBSCT, or WL. Active groups received 8 weekly 1-hour face-to-face group sessions. Biochemically verified smoking abstinence and depressive symptoms were assessed at the end of treatment, and at 3-, 6-, and 12-month follow-ups. Results Significant treatment effects in 7-dayspoint prevalence abstinence rates were found for both active groups at the end of treatment. Abstinence rates at 12-months follow-up were 30% for SCBSCT-BA, and 18% for SCBSCT. Using Multiple Imputation for missing data, regression analysis showed significantly greater ORs for the SCBSCT-BA condition (vs. SCBSCT) at the end of treatment and at 3-months follow-up. At 6-, and 12-months follow-ups, ORs for the SCBSCT-BA condition, although greater, did not reach statistical significance. Multilevel analysis showed that abstinence was related to reductions in depressive symptoms. Conclusions SCBSCT-BA obtained positive results at short and medium term. Participants who quit smoking experienced a significant reduction in depressive symptoms. Findings support the benefit of adding BA to a cognitive-behavioral smoking cessation treatment. Trial registration www.clinicaltrials.govNCT02844595.
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Affiliation(s)
- Carmela Martínez-Vispo
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
- * E-mail:
| | - Rubén Rodríguez-Cano
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Ana López-Durán
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
| | - Carmen Senra
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
| | | | - Elisardo Becoña
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Galicia, Spain
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Stockings E, Black N, Bartlem KM, Metse AP, Regan T, Bailey JM, Wolfenden L, Wiggers J, Bowman JA. Outpatient interventions for smoking cessation and reduction for adults with a mental disorder. Hippokratia 2019. [DOI: 10.1002/14651858.cd013286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Emily Stockings
- University of New South Wales; National Drug and Alcohol Research Centre (NDARC); Sydney Australia
| | - Nicola Black
- University of New South Wales; National Drug and Alcohol Research Centre (NDARC); Sydney Australia
| | - Kate M Bartlem
- University of Newcastle; School of Psychology; University Drive Callaghan New South Wales Australia 2308
| | - Alexandra P Metse
- University of Newcastle; School of Psychology; University Drive Callaghan New South Wales Australia 2308
| | - Tim Regan
- Hunter New England Local Health District; Hunter New England Population Health; Locked Bag 10 Wallsend NSW Australia 2287
| | - Jacqueline M Bailey
- University of Newcastle; School of Psychology; University Drive Callaghan New South Wales Australia 2308
| | - Luke Wolfenden
- University of Newcastle; School of Medicine and Public Health; Callaghan NSW Australia 2308
| | - John Wiggers
- Hunter New England Local Health District; Hunter New England Population Health; Locked Bag 10 Wallsend NSW Australia 2287
| | - Jennifer A Bowman
- University of Newcastle; School of Psychology; University Drive Callaghan New South Wales Australia 2308
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Gómez-Gómez I, Motrico E, Moreno-Peral P, Rigabert A, Conejo-Cerón S, Ortega-Calvo M, Recio JI, Bellón JA. Effectiveness of complex multiple-risk lifestyle interventions in reducing symptoms of depression: a study protocol for a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2019; 9:e026842. [PMID: 30878992 PMCID: PMC6429884 DOI: 10.1136/bmjopen-2018-026842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/11/2019] [Accepted: 01/25/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Many studies have explored the impact of lifestyle interventions on depression. However, little is known about the effectiveness of complex multiple-risk lifestyle interventions in reducing symptoms of depression. Our objective is to assess the effectiveness of complex multiple-risk lifestyle interventions in reducing depressive symptoms in the adult population by the acquisition of at least two healthy habits-healthy diet, physical activity and/or smoking cessation. For such purpose, a systematic review and meta-analysis of randomised controlled trials will be conducted. METHOD AND ANALYSIS MEDLINE (through Ovid and PubMed), Scopus, Cochrane Central Register of Controlled Trials, Web of Science, PsycINFO, OpenGrey Register (System for Information on Grey Literature in Europe) and the International Clinical Trials Registry Platform will be searched for relevant articles. Additionally, a supplementary manual search will be performed using lists of references, references to expert authors and other systematic reviews and/or meta-analyses. Study selection, data extraction (target habits, country, target populations, conditions and statistical data to name a few) and assessment of the risk of bias will be performed separately by two independent researchers. The primary outcome measure will be the reduction of depression symptoms, as measured by validated instruments. We will calculate pooled standardised mean differences and 95% CIs using random-effect models. Heterogeneity, sensitivity and publication bias will be assessed, and sub-group analysis will be performed. Heterogeneity will be explored by random-effects meta-regression analysis. ETHICS AND DISSEMINATION Ethical approval is not required for this study. The results of this systematic review and meta-analysis will be presented in relevant conferences and published in a peer-review journal. The findings of this study could have important clinical and scientific implications for the improvement of symptoms of depression. PROSPERO REGISTRATION NUMBER CRD42018100253; Pre-results.
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Affiliation(s)
- Irene Gómez-Gómez
- Department of Psychology, Universidad Loyola Andalucia, Seville, Spain
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucia, Seville, Spain
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Barcelona, Spain
| | - Patricia Moreno-Peral
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Barcelona, Spain
- Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
- Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain
| | - Alina Rigabert
- Department of Psychology, Universidad Loyola Andalucia, Seville, Spain
| | - Sonia Conejo-Cerón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Barcelona, Spain
- Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
- Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain
| | - Manuel Ortega-Calvo
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Family Medicine, Primary Care Division of Seville, Seville, Spain
| | - José-Ignacio Recio
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Barcelona, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Health Service of Castilla y León (SACyL), Salamanca, Spain
| | - Juan A Bellón
- Prevention and Health Promotion Research Network (redIAPP), ISCIII, Barcelona, Spain
- Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
- Research Unit of the Health District of Primary Care Málaga-Guadalhorce, Málaga, Spain
- Department of Public Health and Psychiatry, University of Málaga (UMA), Málaga, Spain
- El Palo Health Centre, Andalusian Health Service (SAS), Málaga, Spain
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Petroulia I, Kyriakos CN, Papadakis S, Tzavara C, Filippidis FT, Girvalaki C, Peleki T, Katsaounou P, McNeill A, Mons U, Fernández E, Demjén T, Trofor AC, Herbeć A, Zatoński WA, Tountas Y, Fong GT, Vardavas CI. Patterns of tobacco use, quit attempts, readiness to quit and self-efficacy among smokers with anxiety or depression: Findings among six countries of the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2019; 16:A9. [PMID: 31516463 PMCID: PMC6661848 DOI: 10.18332/tid/98965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/26/2018] [Accepted: 10/15/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION We compared smoking behaviors, past quit attempts, readiness to quit and beliefs about quitting among current cigarette smokers with probable anxiety or depression (PAD) to those without PAD, from six European Union (EU) Member States (MS). METHODS A nationally representative cross-sectional sample of 6011 adult cigarette smokers from six EU MS (Germany, Greece, Hungary, Poland, Romania, Spain) was randomly selected through a multistage cluster sampling design in 2016. Respondents were classified as having PAD based on self-reported current diagnosis or treatment for anxiety or depression, or a positive screen for major depression, according to a validated two-item instrument. Sociodemographic characteristics, patterns of tobacco use, past quitting, readiness to quit, self-efficacy and beliefs about quitting were assessed for patients with and without PAD. Logistic regression was used to examine predictors of PAD. All analyses were conducted using the complex samples package of SPSS. RESULTS Among smokers sampled, 21.0% (95% CI: 19.3-22.9) were identified as having PAD. Logistic regression analyses controlling for socioeconomic variables and cigarettes smoked per day found smokers with PAD were more likely to have made an attempt to quit smoking in the past (AOR=1.48; 95% CI: 1.25-1.74), made a quit attempt in the last 12 months (AOR=1.75; 95% CI: 1.45-2.11), and report lower self-efficacy with quitting (AOR=1.83; 95% CI: 1.44-2.32) compared to smokers without PAD. Additionally, it was found that individuals with PAD were more likely to report having received advice to quit from a doctor or health professional and having used quitline support as part of their last quit attempt. CONCLUSIONS Smokers with PAD report a greater interest in quitting in the future and more frequent failed quit attempts than smokers without PAD; however, the high rates of untreated anxiety or depression, nicotine dependence, low confidence in the ability to quit, infrequent use of cessation methods, as well as socioeconomic factors may make quitting difficult.
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Affiliation(s)
- Ioanna Petroulia
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Christina N. Kyriakos
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
| | - Sophia Papadakis
- University of Crete (UoC), Heraklion, Greece
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Chara Tzavara
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Filippos T. Filippidis
- National and Kapodistrian University of Athens (UoA), Athens, Greece
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Theodosia Peleki
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | | | - Ann McNeill
- King’s College London (KCL), London, United Kingdom
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), and Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute (IDIBELL), Catalonia, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, Catalonia, Spain
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Antigona C. Trofor
- Universitatea de Medicina si Farmacie ‘Grigore T. Popa’ Iași, Iași, România
- Aer Pur Romania, Bucharest, Romania
| | | | - Witold A. Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Yannis Tountas
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Geoffrey T. Fong
- Department of Psychology & School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
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Taylor G, Aveyard P, Bartlem K, Shaw A, Player J, Metcalfe C, Kessler D, Munafò M. IntEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety (ESCAPE): protocol for a randomised and controlled, multicentre, acceptability, feasibility and implementation trial. Pilot Feasibility Stud 2019; 5:16. [PMID: 30693096 PMCID: PMC6343330 DOI: 10.1186/s40814-018-0385-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND People with depression/anxiety are twice as likely to smoke and are less responsive to standard tobacco treatments, leading to a reduced life expectancy of up to 13.6 years compared to people without depression/anxiety. However, this group of smokers is motivated to quit, and as a result of quitting smoking, their depression/anxiety is likely to improve. In England, people with depression/anxiety are referred to a primary care-based psychological therapies service known as 'Improving Access to Psychological Therapies' (IAPT), which could offer smoking cessation treatment as part of usual care but currently does not. In this study, we aim (1) to establish the feasibility and acceptability of delivering a smoking cessation treatment alongside IAPT usual care and (2) to establish the feasibility of a multi-centre randomised trial to compare the combined smoking cessation and IAPT treatment to usual IAPT treatment alone. METHODS A randomised and controlled, multi-centre trial to test the acceptability, feasibility and implementation of smoking cessation treatment as offered alongside usual IAPT care, compared to usual care alone, with nested qualitative methods. We will include adult daily smokers with depression/anxiety, who would like help to quit smoking and are about to start IAPT treatment. Follow-up will be conducted at 3-months after baseline. The main outcome will be retention in the smoking cessation treatment. Secondary outcomes are smoking-related (biochemically-verified 7-day point prevalence smoking cessation, number of cigarettes smoked per day, Heaviness of Smoking Index), mental health-related (PHQ-9), service-related (number of 'Did Not Attends', number of planned and completed IAPT sessions), acceptability and feasibility (participant and clinician acceptability and satisfaction of intervention as assessed by questionnaires and qualitative interviews, interviews will also explore acceptability and feasibility of data collection procedures and impact of smoking cessation treatment on usual care and mental health recovery) and implementation-related (intervention delivery checklist, qualitative analysis of intervention delivery). DISCUSSION If the intervention is shown to be acceptable, feasible and suitably implemented, we can conduct a randomised controlled trial. In a future trial, we would examine whether adding smoking cessation treatment increases smoking abstinence and improves depression and anxiety more than usual care, which would lead to long-term health improvement. TRIAL REGISTRATION ISRCTN99531779.
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Affiliation(s)
- Gemma Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, 10 West, Bath, BA2 7AY UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, UK Centre for Tobacco and Alcohol Studies, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter Woodstock Road, Oxford, OX2 6GG UK
| | - Kate Bartlem
- School of Psychology, University of Newcastle, Behavioural Sciences Building, University Drive, Callaghan, 2308 Australia
- Population Health, Hunter New England Local Health District, Wallsend Health Services, Booth Building, Longworth Avenue, Wallsend, NSW 2287 Australia
| | - Alison Shaw
- Centre for Academic Primary Care, Bristol Medical School, Department of Population Health Sciences, Canynge Hall, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jeremy Player
- Jeremy Player, Solutions 4 Health, 7200 The Quorum, Oxford Business Park, Garsington Road, Oxford, OX4 2JZ UK
| | - Chris Metcalfe
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - David Kessler
- Centre for Academic Primary Care, Bristol Medical School, Department of Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Marcus Munafò
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU UK
- MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
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Hartmann-Boyce J, Fanshawe TR, Lindson N, Livingstone-Banks J, Ordóñez-Mena JM, Aveyard P. Behavioural interventions for smoking cessation: an overview and network meta-analysis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2018. [DOI: 10.1002/14651858.cd013229] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jamie Hartmann-Boyce
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - Thomas R Fanshawe
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - Nicola Lindson
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - Jonathan Livingstone-Banks
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - José M. Ordóñez-Mena
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
| | - Paul Aveyard
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford UK OX2 6GG
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Taylor KL, Simpson S, Jelinek GA, Neate SL, De Livera AM, Brown CR, O'Kearney E, Marck CH, Weiland TJ. Longitudinal Associations of Modifiable Lifestyle Factors With Positive Depression-Screen Over 2.5-Years in an International Cohort of People Living With Multiple Sclerosis. Front Psychiatry 2018; 9:526. [PMID: 30425659 PMCID: PMC6218592 DOI: 10.3389/fpsyt.2018.00526] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Depression is common and has a significant impact on quality of life for many people with multiple sclerosis (MS). A preventive management approach via modification of lifestyle risk factors holds potential benefits. We examined the relationship between modifiable lifestyle factors and depression risk and the change in depression over 2.5 years. Methods: Sample recruited using online platforms. 2,224 (88.9%) at baseline and 1,309 (93.4%) at 2.5 years follow up completed the necessary survey data. Depression risk was measured by the Patient Health Questionnaire-2 (PHQ-2) at baseline and Patient Health Questionniare-9 (PHQ-9) at 2.5-years follow-up. Multivariable regression models assessed the relationships between lifestyle factors and depression risk, adjusted for sex, age, fatigue, disability, antidepressant medication use, and baseline depression score, as appropriate. Results: The prevalence of depression risk at 2.5-years follow-up in this cohort was 14.5% using the PHQ-2 and 21.7% using the PHQ-9. Moderate alcohol intake, being a non-smoker, diet quality, no meat or dairy intake, vitamin D supplementation, omega 3 supplement use, regular exercise, and meditation at baseline were associated with lower frequencies of positive depression-screen 2.5 years later. Moderate alcohol intake was associated with greater likelihood of becoming depression-free and a lower likelihood of becoming depressed at 2.5-years follow-up. Meditating at least once a week was associated with a decreased frequency of losing depression risk, against our expectation. After adjusting for potential confounders, smoking, diet, physical activity, and vitamin D and omega-3 supplementation were not associated with a change in risk for depression. Conclusion: In a large prospective cohort study of people with MS and depression, in line with the emerging treatment paradigm of early intervention, these results suggest a role for some lifestyle factors in depression risk. Further studies should endeavor to explore the impact of positive lifestyle change and improving depression in people living with MS.
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Affiliation(s)
- Keryn L. Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Department of Psychiatry and Psychosocial Cancer Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Steve Simpson
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - George A. Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Sandra L. Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Alysha M. De Livera
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Chelsea R. Brown
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Emily O'Kearney
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Claudia H. Marck
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Tracey J. Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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30
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Kahler CW, Surace A, Gordon REF, Cioe PA, Spillane NS, Parks A, Bock BC, Brown RA. Positive psychotherapy for smoking cessation enhanced with text messaging: Protocol for a randomized controlled trial. Contemp Clin Trials 2018; 71:146-153. [PMID: 29936125 PMCID: PMC6484849 DOI: 10.1016/j.cct.2018.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/13/2018] [Accepted: 06/20/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite reductions in cigarette smoking in the U.S., improvements in the efficacy of smoking cessation treatments are needed, as rates of sustained abstinence remain disappointingly low. Both low positive affect and high negative affect contribute to smoking relapse and constitute viable targets for smoking cessation interventions. Although some clinical trials have evaluated interventions to address depression as a smoking relapse risk factor, very few have focused on positive affect. Recently, we developed and conducted a preliminary clinical trial of a smoking cessation treatment that targets positive affect and cognitions by incorporating interventions rooted in positive psychology. The current randomized controlled trial will expand upon this preliminary trial to test whether this positive psychology-informed approach results in higher smoking cessation rates compared to a time-matched standard smoking cessation treatment control. METHODS Three hundred and forty adult daily smokers will be randomly assigned to either positive psychotherapy for smoking cessation or standard behavioral smoking cessation counseling. Participants will meet weekly with a study counselor for 6 weeks and will receive transdermal nicotine patch and text messaging smoking cessation support. Additionally, text messaging in the positive psychotherapy condition will encourage engagement in positive psychology-specific strategies for boosting mood and staying smoke free. Smoking cessation outcomes will be measured at 12, 26, and 52 weeks following target quit date. CONCLUSION Results from this study will provide evidence on whether incorporating positive psychology interventions into smoking cessation treatment can improve smoking cessation outcomes relative to standard behavioral counseling with nicotine patch and text messaging.
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Affiliation(s)
- Christopher W Kahler
- Center for Alcohol and Addiction Studies and the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.
| | - Anthony Surace
- Center for Alcohol and Addiction Studies and the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Rebecca E F Gordon
- Center for Alcohol and Addiction Studies and the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Patricia A Cioe
- Center for Alcohol and Addiction Studies and the Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Nichea S Spillane
- Department of Psychology, University of Rhode Island, Kingston, RI, United States
| | | | - Beth C Bock
- Alpert Medical School of Brown University and The Miriam Hospital, Providence, RI, United States
| | - Richard A Brown
- School of Nursing, University of Texas, Austin, TX, United States
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solak I, Yıldırım Dİ, Gümüş F, Eren İ, Eryılmaz MA. Depresyon ve anksiyetenin sigara bırakma tedavisi üzerine etkisi. KONURALP TIP DERGISI 2018. [DOI: 10.18521/ktd.351519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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32
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Witt DR, Patten CA. Treatment of Tobacco Use Disorder and Mood Disorders in Adolescents. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0216-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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West R, Coyle K, Owen L, Coyle D, Pokhrel S. Estimates of effectiveness and reach for 'return on investment' modelling of smoking cessation interventions using data from England. Addiction 2018; 113 Suppl 1:19-31. [PMID: 28833834 PMCID: PMC6032933 DOI: 10.1111/add.14006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/10/2017] [Accepted: 08/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Estimating 'return on investment' (ROI) from smoking cessation interventions requires reach and effectiveness parameters for interventions for use in economic models such as the EQUIPT ROI tool (http://roi.equipt.eu). This paper describes the derivation of these parameter estimates for England that can be adapted to create ROI models for use by other countries. METHODS Estimates were derived for interventions in terms of their reach and effectiveness in: (1) promoting quit attempts and (2) improving the success of quit attempts (abstinence for at least 12 months). The sources were systematic reviews of efficacy supplemented by individual effectiveness evaluations and national surveys. FINDINGS Quit attempt rates were estimated to be increased by the following percentages (with reach in parentheses): 20% by tax increases raising the cost of smoking 5% above the cost of living index (100%); 10% by enforced comprehensive indoor public smoking bans (100%); 3% by mass media campaigns achieving 400 gross rating points (100%); 40% by brief opportunistic physician advice (21%); and 110% by use of a licensed nicotine product to reduce cigarette consumption (12%). Quit success rates were estimated to be increased by the following ratios: 60% by single-form nicotine replacement therapy (NRT) (5%); 114% by NRT patch plus a faster-acting NRT (2%);124% by prescribed varenicline (5%); 60% by bupropion (1%); 100% by nortriptyline (0%), 10) 298% by cytisine (0%); 40% by individual face-to-face behavioural support (2%); 37% by telephone support (0.5%); 88% by group behavioural support (1%); 63% by text messaging (0.5%); and 19% by printed self-help materials (1%). There was insufficient evidence to obtain reliable, country-specific estimates for interventions such as websites, smartphone applications and e-cigarettes. CONCLUSIONS Tax increases, indoor smoking bans, brief opportunistic physician advice and use of nicotine replacement therapy (NRT) for smoking reduction can all increase population quit attempt rates. Quit success rates can be increased by provision of NRT, varenicline, bupropion, nortriptyline, cytisine and behavioural support delivered through a variety of modalities. Parameter estimates for the effectiveness and reach of these interventions can contribute to return on investment estimates in support of national or regional policy decisions.
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Affiliation(s)
- Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Kathryn Coyle
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
| | - Lesley Owen
- Centre for GuidelinesNational Institute for Health and Care ExcellenceLondonUK
| | - Doug Coyle
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
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Heffner JL, Mull KE, McClure JB, Bricker JB. Positive Affect as a Predictor of Smoking Cessation and Relapse: Does It Offer Unique Predictive Value among Depressive Symptom Domains? Subst Use Misuse 2018; 53:980-988. [PMID: 29161212 PMCID: PMC6159215 DOI: 10.1080/10826084.2017.1387569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Prior studies have suggested that, among the domains of depressive symptoms, low positive affect (PA) may have a distinct relationship with smoking cessation and relapse. However, the empirical basis for PA-focused interventions cessation is limited, with some mixed findings. OBJECTIVES Using a large, diverse sample of treatment-seeking smokers, this study tested the hypothesis that PA adds unique predictive value beyond the effects of the other symptom domains in models of cessation and relapse. METHODS Adult smokers participating in a smoking cessation trial (n = 450) were included in this post hoc analysis. Cessation outcomes included smoking abstinence at end of treatment and at 6-month follow-up. Relapse was defined as recurrence of smoking at 6-month follow-up among the end-of-treatment abstainers. Depressive symptoms were assessed at baseline using the Center for Epidemiologic Studies-Depression (CES-D) scale. RESULTS With the exception of PA, all of the CES-D domains predicted reduced likelihood of smoking abstinence at end of treatment and cotinine-confirmed (but not self-reported) abstinence at 6 months, as did total CES-D score (all p-values < .05). None of the symptom domains predicted relapse. Conclusions/Importance: Our results provide further evidence that current depressive symptoms predict worse cessation outcomes, but they fail to support recent work suggesting that low PA has incremental predictive value for cessation or relapse beyond the other depressive symptom domains. To improve quit rates for smokers with depressive symptoms, evidence-based mood management interventions should be included in treatment planning.
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Affiliation(s)
- Jaimee L Heffner
- a Division of Public Health Sciences , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA
| | - Kristin E Mull
- a Division of Public Health Sciences , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA
| | - Jennifer B McClure
- b Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute) , Seattle , Washington , USA
| | - Jonathan B Bricker
- a Division of Public Health Sciences , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA
- c Department of Psychology , University of Washington , Seattle , Washington , USA
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Minian N, Noormohamed A, Baliunas D, Zawertailo L, Mulder C, Ravindran A, de Oliveira C, Selby P. Tailored Versus Generic Knowledge Brokering to Integrate Mood Management Into Smoking Cessation Interventions in Primary Care Settings: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e111. [PMID: 29703714 PMCID: PMC5948411 DOI: 10.2196/resprot.9715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 12/31/2022] Open
Abstract
Background Both tobacco smoking and depression are major public health problems associated with high morbidity and mortality. In addition, individuals with depression are almost twice as likely to smoke and less likely to achieve smoking cessation. In the Smoking Treatment for Ontario Patients program, an established smoking cessation program in Ontario, Canada, 38% of smokers in primary care settings have current or past depression with 6-month quit rates that are significantly lower than those without depression (33% versus 40%, P<.001). Integrating self-help mood management (eg, relaxation exercises and mood monitoring) with smoking cessation treatment increases long-term quit rates by 12%-20%. However, integration in real-world settings has not been reported. It is unclear which knowledge translation strategy would be more effective for motivating clinicians to provide resources on mood management to eligible patients. Objective The objectives of this study are to investigate the following comparisons among depressed smokers enrolled in a smoking cessation program: 1) the effectiveness of generalized, exclusively email-based prompts versus a personalized knowledge broker in implementing mood management interventions; 2) the effectiveness of the two knowledge translation strategies on smoking quit rates; and 3) the incremental costs of the two knowledge translation strategies on the implementation of mood management interventions. Methods The study design is a cluster randomized controlled trial of Family Health Teams participating in the Smoking Treatment for Ontario Patients program. Family Health Teams will be randomly allocated 1:1 to receive either generalized messages (related to depression and smoking) exclusively via email (group A) or be assigned a knowledge broker who provides personalized support through phone- and email-based check-ins (group B). The primary outcome, measured at the site level, is the proportion of eligible baseline visits that result in the provision of the mood management intervention to eligible patients. Results Recruitment for the primary outcome of this study will be completed in 2018/2019. Results will be reported in 2019/2020. Conclusions This study will address the knowledge gap in the implementation strategies (ie, email-based prompts versus a knowledge broker) of mood management interventions for smokers with depression in primary care settings. Trial Registration ClinicalTrials.gov NCT03130998; https://clinicaltrials.gov/ct2/show/NCT03130998 (Archived on WebCite at www.webcitation.org/6ylyS6RTe)
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Affiliation(s)
- Nadia Minian
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Dolly Baliunas
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Laurie Zawertailo
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Carol Mulder
- The Association of Family Health Teams of Ontario, Toronto, ON, Canada
| | - Arun Ravindran
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Brose LS, Simonavicius E, McNeill A. Maintaining abstinence from smoking after a period of enforced abstinence - systematic review, meta-analysis and analysis of behaviour change techniques with a focus on mental health. Psychol Med 2018; 48:669-678. [PMID: 28780913 PMCID: PMC5681216 DOI: 10.1017/s0033291717002021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Smoking prevalence is doubled among people with mental health problems and reaches 80% in inpatient, substance misuse and prison settings, widening inequalities in morbidity and mortality. As more institutions become smoke-free but most smokers relapse immediately post-discharge, we aimed to review interventions to maintain abstinence post-discharge. METHODS MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science were searched from inception to May 2016 and randomised controlled trials (RCTs) and cohort studies conducted with adult smokers in prison, inpatient mental health or substance use treatment included. Risk of bias (study quality) was rated using the Effective Public Health Practice Project Tool. Behaviour change techniques (BCTs) were coded from published papers and manuals using a published taxonomy. Mantel-Haenszel random effects meta-analyses of RCTs used biochemically verified point-prevalence smoking abstinence at (a) longest and (b) 6-month follow-up. RESULTS Five RCTs (n = 416 intervention, n = 415 control) and five cohort studies (n = 471) included. Regarding study quality, four RCTs were rated strong, one moderate; one cohort study was rated strong, one moderate and three weak. Most common BCTs were pharmacotherapy (n = 8 nicotine replacement therapy, n = 1 clonidine), problem solving, social support, and elicitation of pros and cons (each n = 6); papers reported fewer techniques than manuals. Meta-analyses found effects in favour of intervention [(a) risk ratio (RR) = 2.06, 95% confidence interval (CI) 1.30-3.27; (b) RR = 1.86, 95% CI 1.04-3.31]. CONCLUSION Medication and/or behavioural support can help maintain smoking abstinence beyond discharge from smoke-free institutions with high mental health comorbidity. However, the small evidence base tested few different interventions and reporting of behavioural interventions is often imprecise.
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Affiliation(s)
- L S Brose
- Department of Addictions,Institute of Psychiatry, Psychology and Neuroscience,King's College London,London,UK
| | - E Simonavicius
- Department of Addictions,Institute of Psychiatry, Psychology and Neuroscience,King's College London,London,UK
| | - A McNeill
- Department of Addictions,Institute of Psychiatry, Psychology and Neuroscience,King's College London,London,UK
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Psychological, pharmacological, and combined smoking cessation interventions for smokers with current depression: A systematic review and meta-analysis. PLoS One 2017; 12:e0188849. [PMID: 29206852 PMCID: PMC5716554 DOI: 10.1371/journal.pone.0188849] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/14/2017] [Indexed: 12/30/2022] Open
Abstract
We conducted a systematic literature review and meta-analysis (ID: CRD42016051017) of smoking cessation interventions for patients with current depression. We examined the effectiveness of smoking cessation treatments in improving abstinence rates and depressive symptoms. The following electronic databases were used for potentially eligible studies: PUBMED, PSYCINFO, DIALNET and WEB OF KNOWLEDGE. The search terms used were: smoking cessation, depressive disorder, depression, mood, depressive, depressed, smoking, smokers, nicotine, nicotine dependence, and tobacco cigarette smoking. The methodological quality of included studies was assessed using the Effective Public Health Practice Project Quality assessment tool (EPHPP). Of the 6,584 studies identified, 20 were eligible and included in the review. Trial designs of studies were 16 randomized controlled trials and 4 secondary studies. Studies included three types of intervention: psychological (6/30%), pharmacological (6/30%) or combined (8/40%). Four trials comprised special populations of smokers. Four studies received a strong methodological quality, 7 were scored as moderate and 9 studies received a weak methodological rating. Analyses of effectiveness showed that smoking cessation interventions appear to increase short-term and long-term smoking abstinence in individuals with current depression. Subgroup analyses revealed stronger effects among studies that provided pharmacological treatments than in studies using psychological treatments. However, the evidence is weak due to the small number of studies. Smoking abstinence appears to be associated with an improvement in depressive symptoms. Heterogeneity in protocols in similar types of treatment also prevent firm conclusions being drawn on the effectiveness of any particular treatment model to optimally manage abstinence among depressed smokers. Further research is required to strengthen the evidence base.
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Taylor G, Aveyard P, der Meer RV, Toze D, Stuijfzand B, Kessler D, Munafò M. Impact of variation in functions and delivery on the effectiveness of behavioural and mood management interventions for smoking cessation in people with depression: protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e018617. [PMID: 29150479 PMCID: PMC5702022 DOI: 10.1136/bmjopen-2017-018617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/26/2017] [Accepted: 10/03/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Tobacco is the world's leading preventable cause of disease and death. People with depression are twice as likely to smoke and are less responsive to standard tobacco treatments as compared with the general population. A Cochrane systematic review of randomised controlled trials of smoking cessation treatment for smokers with current or historical depression found that adding mood management to usual smoking treatment improved quit rates. However, the review did not examine if variation in intervention delivery or intervention functions impacted on treatment effectiveness.With the aim of providing information to develop tailored approaches to treating smoking for people with current depression, we will add-on to the Cochrane review in three ways: (1) use the Template for Intervention Description and Replication checklist to determine if variations in mood management delivery have impact on intervention effectiveness, (2) use the Taxonomy of Behaviour Change techniques for smoking cessation to examine which behaviour change functions are most effective for smoking cessation in people with current depression and (3) examine the difference in change in depression scores between intervention and control arms. METHODS AND ANALYSIS We will include randomised controlled trials of smokers with current depression as identified by a previous Cochrane review and the in-progress update of this Cochrane review. We will use meta-regression to examine (1) if variations in delivery of mood management impact on smoking cessation intervention effectiveness, (2) determine which behaviour change functions are most effective for smoking cessation and (3) use meta-analysis of the difference in change in depression scores between treatment arms from baseline to follow-up to determine if offering smoking cessation treatment causes psychological harm. ETHICS AND DISSEMINATION Ethical approval is not required for this study. We will disseminate the findings of this work at national and international conferences, and to relevant patient panels. PROSPERO REGISTRATION NUMBER CRD42017070741.
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Affiliation(s)
- Gemma Taylor
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, UK Centre for Tobacco and Alcohol Studies, University of Oxford, Oxford, UK
| | - Regina Van der Meer
- Department of Epidemiology and Health Promotion, Public Health Service of Haaglanden (GGD Haaglanden), Hague, The Netherlands
- CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Daniel Toze
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Bobby Stuijfzand
- Jean Golding Institute for Data-Intensive Research, University of Bristol, Bristol, UK
| | - David Kessler
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus Munafò
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
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Joly B, Perriot J, d’Athis P, Chazard E, Brousse G, Quantin C. Success rates in smoking cessation: Psychological preparation plays a critical role and interacts with other factors such as psychoactive substances. PLoS One 2017; 12:e0184800. [PMID: 29020085 PMCID: PMC5636087 DOI: 10.1371/journal.pone.0184800] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/31/2017] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The aim of this study was to identify factors associated with the results of smoking cessation attempts. METHODS Data were collected in Clermont-Ferrand from a smoking cessation clinic between 1999 and 2009 (1,361 patients). Smoking cessation was considered a success when patients were abstinent 6 months after the beginning of cessation. Multivariate logistic regression was used to investigate the association between abstinence and different factors. RESULTS The significant factors were a history of depression (ORadjusted = 0.57, p = 0.003), state of depression at the initial consultation (ORa = 0.64, p = 0.005), other psychoactive substances (ORa = 0.52, p<0.0001), heart, lung and Ear-Nose-Throat diseases (ORa = 0.65, p = 0.005), age (ORa = 1.04, p<0.0001), the Richmond test (p<0.0001; when the patient's motivation went from insufficient to moderate, the frequency of abstinence was twice as high) and the Prochaska algorithm (p<0.0001; when the patient went from the 'pre-contemplation' to the 'contemplation' level, the frequency of success was four times higher). A high score in the Richmond test had a greater impact on success with increasing age (significant interaction: p = 0.01). In exclusive smokers, the contemplation level in the Prochaska algorithm was enough to obtain a satisfactory abstinence rate (65.5%) whereas among consumers of other psychoactive substances, it was necessary to reach the preparation level in the Prochaska algorithm to achieve a success rate greater than 50% (significant interaction: p = 0.02). CONCLUSION The psychological preparation of the smoker plays a critical role. The management of smoking cessation must be personalized, especially for consumers of other psychoactive substances and/or smokers with a history of depression.
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Affiliation(s)
- Bertrand Joly
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - Jean Perriot
- Dispensaire Emile Roux, Centre d'Aide à I'Arrêt du Tabagisme (IRAAT), Centre de Lutte Anti-Tuberculeuse (CLAT), Clermont-Ferrand, France
| | - Philippe d’Athis
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
| | - Emmanuel Chazard
- Univ. Lille, CHU Lille, Department of Public Health, Lille, France
| | - Georges Brousse
- Psychiatry B-Department of Addictology, Université Clermont 1, UFR Médecine, Clermont-Ferrand, and CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France; Bourgogne Franche-Comté University, Dijon, France
- INSERM, CIC 1432, Dijon, France; Dijon UniversityHospital, Clinical Investigation Center, Clinicalepidemiology/ Clinical trials unit, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
- * E-mail:
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Rogers ES, Vargas EA. Tobacco retail environment near housing programmes for patients with mental health conditions in New York City. Tob Control 2017; 27:526-533. [PMID: 28855299 DOI: 10.1136/tobaccocontrol-2016-053590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The current study sought to characterise the tobacco retail environment of supportive housing facilities for persons with mental health (MH) conditions in New York City (NYC) and to estimate the potential impact of a tobacco retail ban near public schools on the retail environment of MH housing in NYC. METHODS Texas A&M Geocoding Services was used to geocode the addresses of housing programmes for patients with MH conditions, non-MH residences, public schools and tobacco retailers in NYC. ESRI ArcMap was used to calculate the number of tobacco retailers within a 500-foot radius around each housing programme and school address point, and the Euclidean distance to the nearest retailer. Generalised linear models were used to compare retail counts and distance between MH and non-MH residences. RESULTS The mean number of tobacco retailers within 500 feet of an MH housing programme was 2.9 (SD=2.3) and the mean distance to nearest tobacco retailer was 370.6 feet (SD=350.7). MH residences had more retailers within 500 feet and a shorter distance to the nearest retailer compared with non-MH residences in Brooklyn, the Bronx and Staten Island (p<0.001). Banning tobacco licences within 350, 500 or 1000 feet of a school would significantly improve the tobacco retail environment of MH housing programmes and reduce disparities between MH and non-MH residences in some boroughs. CONCLUSIONS People with MH conditions residing in supportive housing in NYC encounter a heavy tobacco retail environment in close proximity to their home, and in some boroughs, one worse than non-MH residences. Implementing a ban on tobacco retail near public schools would improve the tobacco retail environment of MH housing programmes in NYC.
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Affiliation(s)
- Erin S Rogers
- Department of Population Health, New York University School of Medicine, New York City, New York, USA.,Research Service, VA New York Harbor Healthcare System, New York City, New York, USA
| | - Elizabeth A Vargas
- Department of Population Health, New York University School of Medicine, New York City, New York, USA.,Research Service, VA New York Harbor Healthcare System, New York City, New York, USA
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Stepankova L, Kralikova E, Zvolska K, Pankova A, Ovesna P, Blaha M, Brose LS. Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up. Ann Behav Med 2017; 51:454-463. [PMID: 28035641 PMCID: PMC5440483 DOI: 10.1007/s12160-016-9869-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Smoking is more prevalent among people with depression. Depression may make cessation more difficult and cessation may affect depression symptoms. PURPOSE The aims of this study were to assess the associations between (1) baseline depression and 1-year smoking abstinence and (2) abstinence and change in depression. METHODS Observational study using data collected routinely in a smoking cessation clinic in the Czech Republic from 2008 to 2014. Aim 1: N = 3775 patients; 14.3% reported mild and 15.4% moderate/severe baseline depression levels measured using Beck's Depression Inventory (BDI-II). Logistic regressions assessed if depression level predicted 1-year biochemically verified abstinence while adjusting for patient and treatment characteristics. Aim 2: N = 835 patients abstinent at 1 year; change in depression was analysed using Chi-square statistics, t test and mixed method analyses of variance. RESULTS Rate of abstinence was lower for patients with mild (32.5%, OR = 0.68; 95% CI: 0.54 to 0.87, p = 0.002) and moderate/severe depression (25.8%; OR = 0.57, 95% CI: 0.45 to 0.74, p < 0.001) compared with patients without depression (40.5%). Across abstinent patients, the majority with baseline depression reported lower depression levels at follow-up. Overall mean (SD) BDI-II scores improved from 9.2 (8.6) to 5.3 (6.1); t(834) = 14.6, p < 0.001. There were significant main effects of time (F(1832) = 880.8, p < 0.001, partial η2 = 0.51) and baseline depression level (F(2832) = 666.4, p < 0.001, partial η2 = 0.62) on follow-up depression and a significant depression * time interaction (F(2832) = 296.5, p < 0.001, partial η2 = 0.42). CONCLUSIONS In this effective smoking cessation clinic, depression at the start of treatment predicted reduced smoking abstinence 1 year later. Patients abstinent from smoking experienced considerable improvement in depression.
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Affiliation(s)
- Lenka Stepankova
- Center for Tobacco-Dependent of the 3rd Medical Department—Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Karlovo namesti 32, 128 00 Praha 2, Czech Republic
| | - Eva Kralikova
- Center for Tobacco-Dependent of the 3rd Medical Department—Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Karlovo namesti 32, 128 00 Praha 2, Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital Prague, Studničkova 7, 128 00 Praha 2, Czech Republic
| | - Kamila Zvolska
- Center for Tobacco-Dependent of the 3rd Medical Department—Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Karlovo namesti 32, 128 00 Praha 2, Czech Republic
| | - Alexandra Pankova
- Center for Tobacco-Dependent of the 3rd Medical Department—Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Karlovo namesti 32, 128 00 Praha 2, Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University and General University Hospital Prague, Studničkova 7, 128 00 Praha 2, Czech Republic
| | - Petra Ovesna
- Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science, Masaryk University, Kamenice 126/3, 625 00 Brno, Czech Republic
| | - Milan Blaha
- Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science, Masaryk University, Kamenice 126/3, 625 00 Brno, Czech Republic
| | - Leonie S Brose
- Psychology and Neuroscience, King’s College London, UK and UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, SE5 8BB London, UK
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Sotiriou I, Chalkiadaki K, Nikolaidis C, Sidiropoulou K, Chatzaki E. Pharmacotherapy in smoking cessation: Corticotropin Releasing Factor receptors as emerging intervention targets. Neuropeptides 2017; 63:49-57. [PMID: 28222901 DOI: 10.1016/j.npep.2017.02.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/29/2022]
Abstract
Smoking represents perhaps the single most important health risk factor and a global contributor to mortality that can unquestionably be prevented. Smoking is responsible for many diseases, including various types of cancer, chronic obstructive pulmonary disease, coronary heart disease, peripheral vascular disease and peptic ulcer, while it adversely affects fetal formation and development. Since smoking habit duration is a critical factor for mortality, the goal of treatment should be its timely cessation and relapse prevention. Drug intervention therapy is an important ally in smoking cessation. Significant positive steps have been achieved in the last few years in the development of supportive compounds. In the present review, we analyze reports studying the role of Corticotropin Releasing Factor (CRF), the principle neuroendocrine mediator of the stress response and its two receptors (CRF1 and CRF2) in the withdrawal phase as well as in the abstinence from nicotine use. Although still in pre-clinical evaluation, therapeutic implications of these data were investigated in order to highlight potential pharmaceutical interventions.
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Affiliation(s)
- Ioannis Sotiriou
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | | | - Christos Nikolaidis
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | | | - Ekaterini Chatzaki
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis 68100, Greece.
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Barros MBDA, Lima MG, Azevedo RCSD, Medina LBDP, Lopes CDS, Menezes PR, Malta DC. Depression and health behaviors in Brazilian adults - PNS 2013. Rev Saude Publica 2017; 51:8s. [PMID: 28591352 PMCID: PMC5676399 DOI: 10.1590/s1518-8787.2017051000084] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/18/2016] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To evaluate the prevalence of health-related behaviors according to presence and type of depression in Brazilian adults. METHODS Based on a sample of 49,025 adults (18 to 59 years) from the National Survey on Health 2013 (PNS 2013), we estimated the prevalence of health-related behaviors (smoking; passive smoking; frequent or risky alcohol consumption; leisure time physical activity; time watching TV; and eating pattern indicators), according to the presence of depression (minor and major), evaluated by the Patient Health Questionnaire – 9 (PHQ-9), and the report of depressive mood (in up to seven days or more than seven days) over a two-week period. Prevalence ratios were estimated by Poisson regression. RESULTS Evaluated by the PHQ-9 scale, 9.7% of the Brazilian adults had depression and 3.9% presented major depression. About 21.0% reported depressive mood and, in 34.9% of them, that feeling has been present for more than seven days. In individuals with major depression (PHQ-9), higher prevalence was found in almost all unhealthy behaviors analyzed, in particular, smoking (PR = 1.65), passive smoking (PR = 1.55), risk alcohol consumption (PR = 1.72), TV for ≥ 5 hours/day (PR = 2.13), consumption of fat meat (PR = 1.43) and soft drink (PR = 1.42). The prevalence ratios tended to be lower in those with minor depression. Similar results were observed in adults with depressive mood. CONCLUSIONS This study detected relevant association between depression and health behaviors, in particular for smoking and physical activity. The associations found with the PHQ were similar to those observed with the application of a single question about depressive mood. Our results indicate the importance of assessing the presence of depression and the frequency and severity of symptoms when implementing actions for the promotion of healthy behaviors.
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Affiliation(s)
| | - Margareth Guimarães Lima
- Departamento de Saúde Coletiva. Faculdade de Ciências Médicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
| | - Renata Cruz Soares de Azevedo
- Departamento de Psicologia Médica e Psiquiatria. Faculdade de Ciências Médicas. Universidade Estadual de Campinas. Campinas, SP, Brasil
| | | | - Claudia de Souza Lopes
- Departamento de Epidemiologia. Instituto de Medicina Social. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil
| | - Paulo Rossi Menezes
- Departamento de Medicina Preventiva. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil
| | - Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública. Escola de Enfermagem. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
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Becoña E, Martínez-Vispo C, Senra C, López-Durán A, Rodríguez-Cano R, Fernández del Río E. Cognitive-behavioral treatment with behavioral activation for smokers with depressive symptomatology: study protocol of a randomized controlled trial. BMC Psychiatry 2017; 17:134. [PMID: 28390417 PMCID: PMC5385057 DOI: 10.1186/s12888-017-1301-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/03/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Smoking is an important risk factor for mental health-related problems. Numerous studies have supported a bi-directional association between cigarette smoking and depression. Despite the advances in understanding the comorbidity between both problems, the most effective psychological treatment that simultaneously targets smoking and depressive symptomatology remains unclear. The objective of this study is to assess the effectiveness of a cognitive-behavioral intervention for smoking cessation with components of behavioral activation for managing depressed mood. METHOD A single blind, three-arm, superiority randomized controlled trial is proposed. Participants will be smokers over 18 years old, who smoke at least 8 cigarettes per day. Participants will be randomized to one of three conditions, using a 2:2:1 allocation ratio: 1) standard cognitive-behavioral smoking cessation treatment; 2) standard cognitive-behavioral smoking cessation treatment plus behavioral activation; or 3) a three-month delayed treatment control group. The primary outcome measures will be biochemically verified point-prevalence abstinence (carbon monoxide in expired air) and significant change from baseline in depressive symptoms to the end of treatment, and at the 3-, 6-, and 12-month follow-up. DISCUSSION This study aims to assess the efficacy of a cognitive-behavioral intervention with behavioral activation components for smoking cessation and depressive symptoms, compared to a standard cognitive-behavioral intervention to quit smoking. As the relation between depressive symptoms, even at subclinical levels, and quitting smoking difficulties is well known, we expect that such intervention will allow obtaining higher abstinence rates, lower relapse rates, and mood improvement. TRIAL REGISTRATION ClinicalTrials.gov : NCT02844595 . Retrospectively registered 19th July, 2016. The study started in January 2016, and the recruitment is ongoing.
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Affiliation(s)
- Elisardo Becoña
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia Spain
| | - Carmela Martínez-Vispo
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia Spain
| | - Carmen Senra
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia Spain
| | - Ana López-Durán
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia Spain
| | - Rubén Rodríguez-Cano
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia Spain
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Mathew AR, Hogarth L, Leventhal AM, Cook JW, Hitsman B. Cigarette smoking and depression comorbidity: systematic review and proposed theoretical model. Addiction 2017; 112:401-412. [PMID: 27628300 PMCID: PMC5296249 DOI: 10.1111/add.13604] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/29/2016] [Accepted: 09/05/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Despite decades of research on co-occurring smoking and depression, cessation rates remain consistently lower for depressed smokers than for smokers in the general population, highlighting the need for theory-driven models of smoking and depression. This paper provides a systematic review with a particular focus upon psychological states that disproportionately motivate smoking in depression, and frame an incentive learning theory account of smoking-depression co-occurrence. METHODS We searched PubMed, Scopus, PsychINFO and CINAHL to December 2014, which yielded 852 papers. Using pre-established eligibility criteria, we identified papers focused on clinical issues and motivational mechanisms underlying smoking in established, adult smokers (i.e. maintenance, quit attempts and cessation/relapse) with elevated symptoms of depression. Two reviewers determined independently whether papers met review criteria. We included 297 papers in qualitative synthesis. RESULTS Our review identified three primary mechanisms that underlie persistent smoking among depressed smokers: low positive affect, high negative affect and cognitive impairment. We propose a novel application of incentive learning theory which posits that depressed smokers experience greater increases in the expected value of smoking in the face of these three motivational states, which promotes goal-directed choice of smoking behavior over alternative actions. CONCLUSIONS The incentive learning theory accounts for current evidence on how depression primes smoking behavior and provides a unique framework for conceptualizing psychological mechanisms of smoking maintenance among depressed smokers. Treatment should focus upon correcting adverse internal states and beliefs about the high value of smoking in those states to improve cessation outcomes for depressed smokers.
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Affiliation(s)
- Amanda R. Mathew
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | | | - Adam M. Leventhal
- Departments of Preventive Medicine and Psychology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Jessica W. Cook
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
- William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
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Chamberlain C, O'Mara‐Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2017; 2:CD001055. [PMID: 28196405 PMCID: PMC6472671 DOI: 10.1002/14651858.cd001055.pub5] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors. SELECTION CRITERIA Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, with meta-regression conducted in STATA 14. MAIN RESULTS The overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.In separate comparisons, there is high-quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small.Evidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention.There was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20).High-quality evidence suggests incentive-based interventions are effective when compared with an alternative (non-contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I2 = 93%).High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health.The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32).Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions.The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions. AUTHORS' CONCLUSIONS Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update.
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Affiliation(s)
- Catherine Chamberlain
- La Trobe UniversityJudith Lumley Centre251 Faraday StreetMelbourneVicAustralia3000
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - Alison O'Mara‐Eves
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Jessie Porter
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
| | - Tim Coleman
- University of NottinghamDivision of Primary CareD1411, Medical SchoolQueen's Medical CentreNottinghamUKNG7 2UH
| | - Susan M Perlen
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Joanne E McKenzie
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
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Piper ME, Schlam TR, Cook JW, Smith SS, Bolt DM, Loh WY, Mermelstein R, Collins LM, Fiore MC, Baker TB. Toward precision smoking cessation treatment I: Moderator results from a factorial experiment. Drug Alcohol Depend 2017; 171:59-65. [PMID: 28013098 PMCID: PMC5263119 DOI: 10.1016/j.drugalcdep.2016.11.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/08/2016] [Accepted: 11/15/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND The development of tobacco use treatments that are effective for all smokers is critical to improving clinical and public health. The Multiphase Optimization Strategy (MOST) uses highly efficient factorial experiments to evaluate multiple intervention components for possible inclusion in an optimized tobacco use treatment. Factorial experiments permit analyses of the influence of patient characteristics on main and interaction effects of multiple, relatively discrete, intervention components. This study examined whether person-factor and smoking characteristics moderated the main or interactive effects of intervention components on 26-week self-reported abstinence rates. METHODS This fractional factorial experiment evaluated six smoking cessation intervention components among primary care patients (N=637): Prequit Nicotine Patch vs. None, Prequit Nicotine Gum vs. None, Preparation Counseling vs. None, Intensive Cessation In-Person Counseling vs. Minimal, Intensive Cessation Telephone Counseling vs. Minimal, and 16 vs. 8 Weeks of Combination Nicotine Replacement Therapy (NRT; nicotine patch+nicotine gum). RESULTS Both psychiatric history and smoking heaviness moderated intervention component effects. In comparison with participants with no self-reported history of a psychiatric disorder, those with a positive history showed better response to 16- vs. 8-weeks of combination NRT, but a poorer response to counseling interventions. Also, in contrast to light smokers, heavier smokers showed a poorer response to counseling interventions. CONCLUSIONS Heavy smokers and those with psychiatric histories demonstrated a differential response to intervention components. This research illustrates the use of factorial designs to examine the interactions between person characteristics and relatively discrete intervention components. Future research is needed to replicate these findings.
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Affiliation(s)
- Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States.
| | - Tanya R Schlam
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States
| | - Jessica W Cook
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States; William S. Middleton Memorial Veterans Hospital, United States
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States
| | - Daniel M Bolt
- University of Wisconsin, Department of Educational Psychology, United States
| | - Wei-Yin Loh
- University of Wisconsin, Department of Statistics, United States
| | - Robin Mermelstein
- University of Illinois at Chicago, Institute for Health Research and Policy, United States
| | - Linda M Collins
- The Methodology Center and Department of Human Development and Family Studies, The Pennsylvania State University, United States
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of General Internal Medicine, United States
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Dervaux A, Laqueille X. Tabagisme et comorbidités psychiatriques. Presse Med 2016; 45:1133-1140. [DOI: 10.1016/j.lpm.2016.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/08/2016] [Indexed: 01/17/2023] Open
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Apollonio D, Philipps R, Bero L. Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders. Cochrane Database Syst Rev 2016; 11:CD010274. [PMID: 27878808 PMCID: PMC6464324 DOI: 10.1002/14651858.cd010274.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Smoking rates in people with alcohol and other drug dependencies are two to four times those of the general population. Concurrent treatment of tobacco dependence has been limited due to concern that these interventions are not successful in this population or that recovery from other addictions could be compromised if tobacco cessation was combined with other drug dependency treatment. OBJECTIVES To evaluate whether interventions for tobacco cessation are associated with tobacco abstinence for people in concurrent treatment for or in recovery from alcohol and other drug dependence. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and clinicaltrials.gov databases, with the most recent search completed in August 2016. A grey literature search of conference abstracts from the Society on Nicotine Research and Treatment and the ProQuest database of digital dissertations yielded one additional study, which was excluded. SELECTION CRITERIA We included randomised controlled trials assessing tobacco cessation interventions among people in concurrent treatment for alcohol or other drug dependence or in outpatient recovery programmes. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study risk of bias and extracted data. We resolved disagreements by consensus. The primary outcome was abstinence from tobacco use at the longest period of follow-up, and the secondary outcome was abstinence from alcohol or other drugs, or both. We reported the strictest definition of abstinence. We summarised effects as risk ratios and 95% confidence intervals (CI). Two clustered studies did not provide intraclass correlation coefficients, and were excluded from the sensitivity analysis. We used the I2 statistic to assess heterogeneity. MAIN RESULTS Thirty-five randomised controlled trials, one ongoing, involving 5796 participants met the criteria for inclusion in this review. Included studies assessed the efficacy of tobacco cessation interventions, including counselling, and pharmacotherapy consisting of nicotine replacement therapy (NRT) or non-NRT, or the two combined, in both inpatient and outpatient settings for participants in treatment and in recovery. Most studies did not report information to assess the risk of allocation, selection, and attrition bias, and were classified as unclear.Analyses considered the nature of the intervention, whether participants were in treatment or recovery and the type of dependency. Of the 34 studies included in the meta-analysis, 11 assessed counselling, 11 assessed pharmacotherapy, and 12 assessed counselling in combination with pharmacotherapy, compared to usual care or no intervention. Tobacco cessation interventions were significantly associated with tobacco abstinence for two types of interventions. Pharmacotherapy appeared to increase tobacco abstinence (RR 1.60, 95% CI 1.22 to 2.12, 11 studies, 1808 participants, low quality evidence), as did combined counselling and pharmacotherapy (RR 1.74, 95% CI 1.39 to 2.18, 12 studies, 2229 participants, low quality evidence) at the period of longest follow-up, which ranged from six weeks to 18 months. There was moderate evidence of heterogeneity (I2 = 56% with pharmacotherapy and 43% with counselling plus pharmacotherapy). Counselling interventions did not significantly increase tobacco abstinence (RR 1.33, 95% CI 0.90 to 1.95).Interventions were significantly associated with tobacco abstinence for both people in treatment (RR 1.99, 95% CI 1.59 to 2.50) and people in recovery (RR 1.33, 95% CI 1.06 to 1.67), and for people with alcohol dependence (RR 1.47, 95% CI 1.20 to 1.81) and people with other drug dependencies (RR 1.85, 95% CI 1.43 to 2.40).Offering tobacco cessation therapy to people in treatment or recovery for other drug dependence was not associated with a difference in abstinence rates from alcohol and other drugs (RR 0.97, 95% CI 0.91 to 1.03, 11 studies, 2231 participants, moderate evidence of heterogeneity (I2 = 66%)).Data on adverse effect of the interventions were limited. AUTHORS' CONCLUSIONS The studies included in this review suggest that providing tobacco cessation interventions targeted to smokers in treatment and recovery for alcohol and other drug dependencies increases tobacco abstinence. There was no evidence that providing interventions for tobacco cessation affected abstinence from alcohol and other drugs. The association between tobacco cessation interventions and tobacco abstinence was consistent for both pharmacotherapy and combined counselling and pharmacotherapy, for participants both in treatment and in recovery, and for people with alcohol dependency or other drug dependency. The evidence for the interventions was low quality due primarily to incomplete reporting of the risks of bias and clinical heterogeneity in the nature of treatment. Certain results were sensitive to the length of follow-up or the type of pharmacotherapy, suggesting that further research is warranted regarding whether tobacco cessation interventions are associated with tobacco abstinence for people in recovery, and the outcomes associated with NRT versus non-NRT or combined pharmacotherapy. Overall, the results suggest that tobacco cessation interventions incorporating pharmacotherapy should be incorporated into clinical practice to reduce tobacco addiction among people in treatment for or recovery from alcohol and other drug dependence.
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Affiliation(s)
- Dorie Apollonio
- University of California San FranciscoClinical Pharmacy3333 California StreetSuite 420San FranciscoCAUSA94143‐0613
| | | | - Lisa Bero
- Charles Perkins Centre and Faculty of Pharmacy, University of Sydney6th Floor (6W76)The University of SydneySydneyNew South Wales 2006Australia
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Fan H, Song F, Gu H, Wang J, Jia G, Lu M, Qian J, Wang L, Shen J, Ren Z. An assessment of factors associated with quality of randomized controlled trials for smoking cessation. Oncotarget 2016; 7:53762-53771. [PMID: 27449103 PMCID: PMC5288219 DOI: 10.18632/oncotarget.10742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/10/2016] [Indexed: 11/25/2022] Open
Abstract
To reduce smoking-related diseases, a research priority is to develop effective interventions for smoking cessation, and evidence from randomized controlled trials (RCTs) is usually considered to be the most valid. However, findings from RCTs may still be misleading due to methodological flaws. This study aims to assess the quality of 1083 RCTs of smoking cessation interventions in 41 relevant Cochrane Systematic Reviews (CSRs). Logistic regression analysis was performed to identify significant variables associated with the quality of RCTs. It was found that evidence for smoking cessation from RCTs was predominantly from high income countries, and the overall quality was high in only 8.6% of the RCTs. High quality RCTs tended to have a larger sample size, to be more recently published, and conducted in multiple countries belonging to different income categories. In conclusion, the overall quality of RCTs of smoking cessation interventions is far from perfect, and more RCTs in less developed countries are required to generate high grade evidence for global tobacco control. Collaboration between researchers in developed and less developed countries should be encouraged.
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Affiliation(s)
- Hong Fan
- Center for Health Policy and Management Research, Nanjing University, Nanjing, P.R.China
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Fujian Song
- Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Hai Gu
- Center for Health Policy and Management Research, Nanjing University, Nanjing, P.R.China
| | - Jianming Wang
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Guizhen Jia
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Moyuan Lu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Jiao Qian
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Lei Wang
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Jiemiao Shen
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
| | - Zhewen Ren
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R.China
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