1
|
Sreeramareddy CT, Kuan LP. Smoking Cessation and Utilization of Cessation Assistance in 13 low- and middle-income countries - changes between Two Survey Rounds of Global Adult Tobacco Surveys, 2009-2021. J Epidemiol Glob Health 2024; 14:1257-1267. [PMID: 39133364 PMCID: PMC11442961 DOI: 10.1007/s44197-024-00283-9] [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: 03/24/2024] [Accepted: 07/30/2024] [Indexed: 08/13/2024] Open
Abstract
INTRODUCTION Monitoring changes in cessation behaviors and cessation assistance is critical for policymaking. METHODS We analyzed two rounds (2009-2014 and 2015-2021) of Global Adult Tobacco Surveys in 13 countries. We estimated the quit ratio, quit attempt, and utilization of cessation assistance. The availability of cessation services was obtained from World Health Organization reports. We calculated absolute and relative changes in quit ratio, quit attempt, and cessation assistance. We assessed socio-economic determinants of cessation behaviors by binary logistic regression analyses on pooled data. RESULTS In all countries during both rounds smoking prevalence was 7.6-33.8%, the quit ratio was 0.15-0.54%, and the quit attempt was 17.7-52.8%. Quit ratio improved in Indonesia by 100% but declined in Turkey by 56%. Quit attempts increased in Indonesia (31.9%), Mexico (16.9%) and China (15.9%) but decreased in Turkey (140.4%), Vietnam (43.1%), and Romania (62.4%). In both rounds, using at least one method was 12.5-99.8% while the WHO-recommended method was 4.1-88.4%. In both rounds "try to quit without any assistance" and "other methods" were the most frequently reported cessation assistance. Nicotine replacement therapy (0.2-25.3%) was frequently used as recommended cessation assistance. Nicotine replacement therapy was available in most countries but not quitline and support services. CONCLUSION Limited progress was made in smoking cessation behaviors and cessation assistance in most countries. Health education to improve demand for smoking cessation and availability of evidence-based, low-cost smoking cessation assistance including quit-smoking may improve quit ratios in the population.
Collapse
Affiliation(s)
- Chandrashekhar T Sreeramareddy
- Division of Community Medicine and Public Health, International Medical University, Kuala Lumpur, Malaysia.
- Centre for Translational Research Institute for Research Development and Innovation, International Medical University, Kuala Lumpur, Malaysia.
| | - Lai Pei Kuan
- Centre for Translational Research Institute for Research Development and Innovation, International Medical University, Kuala Lumpur, Malaysia
| |
Collapse
|
2
|
Deng X, Shang X, Guo K, Zhou L, Wang Y, Wu Y, Liang S, E F, Liu W, Wang Z, Li X, Yang K. Efficacy and safety of antidepressants for smoking cessation: A systematic review and network meta-analysis. Addict Biol 2023; 28:e13303. [PMID: 37500482 DOI: 10.1111/adb.13303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/21/2023] [Accepted: 05/30/2023] [Indexed: 07/29/2023]
Abstract
To evaluate the effectiveness, safety and tolerability of antidepressants in helping smokers quit tobacco dependence, five databases were searched for randomized controlled trials (RCTS ) on different antidepressant interventions involving smoking cessation in populations (September 2022). The STATA 15.1 software was used to perform network meta-analysis. The Cochrane bias risk tool was used to assess the risk of bias, and CINeMA was used to evaluate the evidence credibility for the effect of different interventions on smoking cessation. In all, 107 RCTs involving 42 744 patients were included. Seven studies were rated as having a low risk of bias. All trials reported 18 interventions and 153 pairwise comparisons were generated. The network meta-analysis showed that compared with placebo, varenicline + bupropion (OR = 3.53, 95% CI [2.34, 5.34]), selegiline + nicotine replacement therapy (NRT) (OR = 3.78, 95% CI [1.20, 11.92]), nortriptyline + NRT (OR = 2.33, 95% CI [1.21, 4.47), nortriptyline (OR = 1.58, 95% CI [1.11,2.26]), naltrexone + bupropion (OR = 3.84, 95% CI [1.39, 10.61]), bupropion + NRT (OR = 2.29, 95% CI [1.87, 2.81]) and bupropion (OR = 1.70, 95% CI [1.53, 1.89]) showed benefits with respect to smoking cessation. In addition, bupropion + NRT showed better effects than bupropion (OR = 1.35, 95% CI [1.12, 1.64]) and NRT (OR = 1.38, 95% CI [1.13, 1.69]) alone. The final cumulative ranking curve showed that varenicline + bupropion was the most likely to be the best intervention. There was moderate- to very-low-certainty evidence that most interventions showed benefits for smoking cessation compared with placebo, including monotherapy and combination therapies. Varenicline + bupropion had a higher probability of being the best intervention for smoking cessation.
Collapse
Affiliation(s)
- Xinxin Deng
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xue Shang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Kangle Guo
- Gansu Provincial Hospital, Lanzhou, China
| | - Liying Zhou
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Yongsheng Wang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Yanan Wu
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Shanshan Liang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Fenfen E
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Wendi Liu
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Ziyi Wang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiuxia Li
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Kehu Yang
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| |
Collapse
|
3
|
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] [Key Words] [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.
Collapse
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
| |
Collapse
|
4
|
Shah G, Bhatt U, Soni V. Cigarette: an unsung anthropogenic evil in the environment. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:59151-59162. [PMID: 37055684 DOI: 10.1007/s11356-023-26867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023]
Abstract
The world's population is growing steadily, and this trend is mirrored by a sharp rise in the number of people who smoke cigarettes. Instead of properly disposing of their cigarette waste, most people simply toss them aside, leading to serious environmental consequences. According to previous statistics, in 2012 alone, 6.25 trillion cigarettes were consumed by 967 million chain smokers. Past studies have shown that up to 30% of global litter is made up of cigarette waste. These discarded cigarette butts are non-biodegradable and contain over 7000 toxicants such as benzene, 1,3-butadiene, nitrosamine ketone, N-Nitrosonornicotine, nicotine, formaldehyde, acrolein, ammonia, aniline, polycyclic aromatic hydrocarbons, and various heavy metals. These toxicants have a negative impact on the habitats of wildlife and can cause serious health problems such as cancer, respiratory disorders, cardiac issues, and sexual dysfunction. Although it is still unclear how littered cigarettes affect plant growth, germination, and development, it is clear that they have the potential to harm plant health. Just like single-use plastic, trashed cigarette butts are a critical new rising form of pollution that requires scientific attention for effective recycling and disposal management. It is important to properly dispose of cigarette waste to protect the environment and wildlife, as well as to prevent harm to human health.
Collapse
Affiliation(s)
- Garishma Shah
- Plant Bioenergetics and Biotechnology Laboratory, Department of Botany, Mohanlal Sukhadia University, Udaipur, 313001, Rajasthan, India
| | - Upma Bhatt
- Plant Bioenergetics and Biotechnology Laboratory, Department of Botany, Mohanlal Sukhadia University, Udaipur, 313001, Rajasthan, India
| | - Vineet Soni
- Plant Bioenergetics and Biotechnology Laboratory, Department of Botany, Mohanlal Sukhadia University, Udaipur, 313001, Rajasthan, India.
| |
Collapse
|
5
|
Nguyen CV, Le TT, Nguyen NH, Hoang KT. Socioeconomic inequality in smoking: Evidence from a decomposition analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2022.101213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|
6
|
Ayano G, Solomon M, Hibdiye G, Duko B. The epidemiology of tobacco use in Ethiopia: a systematic review and meta-analysis. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
7
|
Alanazi H, Rouabhia M. Effect of e-cigarette aerosol on gingival mucosa structure and proinflammatory cytokine response. Toxicol Rep 2022; 9:1624-1631. [DOI: 10.1016/j.toxrep.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/20/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022] Open
|
8
|
Taylor WC, Winslade WJ. Nonsmokers-only hiring policies: personal liberty vs. promoting public health. ETHICS & BEHAVIOR 2021. [DOI: 10.1080/10508422.2021.1932501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Wendell C. Taylor
- Institute for Bioethics and Health Humanities, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch
| | - William J. Winslade
- Institute for Bioethics and Health Humanities, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch
| |
Collapse
|
9
|
Baker J, Masood M, Rahman MA, Thornton L, Begg S. Tobacco retailer density and smoking behavior in a rural Australian jurisdiction without a tobacco retailer licensing system. Tob Induc Dis 2021; 19:39. [PMID: 34045936 PMCID: PMC8133357 DOI: 10.18332/tid/134190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION An emerging body of research has developed around tobacco retailer density and its contribution to smoking behavior. This cross-sectional study aimed to determine the association between tobacco retailer density and smoking behavior in a rural Australian jurisdiction without a tobacco retailer licensing system in place. METHODS A local government database (updated 2018) of listed tobacco retailers (n=93) was accessed and potential unlisted tobacco retailers (n=230) were added using online searches. All retailers (n=323) were visited in 2019 and GPS coordinates of retailers that sold tobacco (n=125) were assigned to suburbs in ArcMap. A community survey conducted in the Local Government Area provided smoking and sociodemographic data amongst adult respondents (n=8981). Associations between tobacco retailer density (calculated as the number of retailers per km2 based on respondents’ suburb of residence) and daily, occasional and experimental smoking were assessed using multilevel logistic regression analysis. Separate models with and without covariates were undertaken. RESULTS Without adjusting for possible confounders, living in suburbs with greater retailer density did not increase the odds of daily smoking (OR=1.01; 95% CI: 0.92–1.12), occasional smoking (OR=1.05; 95% CI: 0.94–1.18), or experimental smoking (OR=0.98; 95% 0.92– 1.05). However, after adjustment, living in suburbs with greater retailer density increased the odds of occasional smoking behavior (AOR=1.37; 95% CI: 1.10–1.71) but not daily or experimental smoking. CONCLUSIONS This study found a significant positive association between tobacco retailer density and the likelihood of occasional smoking in a rural Australian jurisdiction without a tobacco retailer licensing system in place. The findings strengthen calls for the introduction of a comprehensive, positive tobacco retailer licensing system to provide a framework for improving compliance with legislation and to reduce the overall availability of tobacco products in the community.
Collapse
Affiliation(s)
- John Baker
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Mohd Masood
- Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia.,Institute of Dentistry, University of Turku, Turku, Finland
| | - Muhammad Aziz Rahman
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Australia.,School of Health, Federation University, Berwick, Australia
| | - Lukar Thornton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Stephen Begg
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| |
Collapse
|
10
|
Tregobov N, Poureslami I, Shum J, Aran N, McMillan A, FitzGerald JM. Assessing factors influencing smoking and smoking cessation within Chinese communities in the Greater Vancouver Area: A qualitative exploratory study. Tob Prev Cessat 2020; 6:57. [PMID: 33163703 PMCID: PMC7643582 DOI: 10.18332/tpc/126631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/14/2020] [Accepted: 08/21/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The prevalence of smoking is high within Chinese-Canadian communities and there is a lack of culturally and linguistically appropriate smoking cessation resources and services. We aimed to ascertain factors affecting smoking and smoking cessation from the perspectives of current smokers and key informants. METHODS As part of a multistage mixed-methods study taking place from January 2013 to June 2014, a qualitative exploratory study design was conducted applying a community-based participatory research approach. Focus groups and interviews were conducted with adult (aged ≥19 years) Chinese-Canadian current smokers (≥5 cigarettes per day for the past 30 days) and interviews were held with key informants in Vancouver, Canada. A constant comparison method was applied to code data, and an inductive approach was used to identify emergent themes. RESULTS In all, 35 smokers from the target communities (11 female, 24 male) participated in 4 focus group sessions and 17 key informants (14 female, 3 male) were individually interviewed. Internal and external factors influencing smoking onset, continuation, and cessation from the perspectives of smokers and key informants were identified. Male smokers thought that the most influential factor influencing smoking initiation was social pressure, while female smokers thought that it was stress. Female smokers reported refraining from seeking cessation assistance due to a perceived negative image of female smokers within the community. Both key informants and participants indicated that involving friends and family in the quitting process may help to motivate smokers. CONCLUSIONS Smokers from Chinese-Canadian communities may benefit from linguistically appropriate and culturally relevant smoking cessation interventions that consider prevailing attitudes, perceptions, and beliefs. The knowledge gained may inform the development of future smoking cessation programs and resources for the target community, while our approach may be applicable to other ethnocultural or immigrant communities.
Collapse
Affiliation(s)
- Noah Tregobov
- Division of Respiratory Medicine, Centre for Heart and Lung Health, Vancouver Coastal Health Research Institute, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.,Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital, University of British Columbia Hospital, Vancouver, Canada.,Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Iraj Poureslami
- Division of Respiratory Medicine, Centre for Heart and Lung Health, Vancouver Coastal Health Research Institute, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.,Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital, University of British Columbia Hospital, Vancouver, Canada
| | - Jessica Shum
- Division of Respiratory Medicine, Centre for Heart and Lung Health, Vancouver Coastal Health Research Institute, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.,Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital, University of British Columbia Hospital, Vancouver, Canada
| | - Niloufar Aran
- Division of Respiratory Medicine, Centre for Heart and Lung Health, Vancouver Coastal Health Research Institute, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.,Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital, University of British Columbia Hospital, Vancouver, Canada
| | - Austin McMillan
- Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine, Centre for Heart and Lung Health, Vancouver Coastal Health Research Institute, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.,Gordon and Leslie Diamond Health Care Centre, Vancouver General Hospital, University of British Columbia Hospital, Vancouver, Canada
| |
Collapse
|
11
|
Zawertailo L, Hendershot CS, Tyndale RF, Le Foll B, Samokhvalov AV, Thorpe KE, Pipe A, Reid RD, Selby P. Personalized dosing of nicotine replacement therapy versus standard dosing for the treatment of individuals with tobacco dependence: study protocol for a randomized placebo-controlled trial. Trials 2020; 21:592. [PMID: 32600406 PMCID: PMC7325031 DOI: 10.1186/s13063-020-04532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/18/2020] [Indexed: 11/22/2022] Open
Abstract
Background Medications for smoking cessation are currently only effective in helping a minority of smokers quit. Drug development is slow and expensive; as such, there is much interest in optimizing the effectiveness of existing treatments and medications. Current standard doses of nicotine replacement therapy are not effective for many smokers, and in many cases, the amount of nicotine provided is much less than when a smoker is smoking their usual number of cigarettes. The proposed study will test if titrating the dose of the nicotine patch (up to 84 mg) will improve quitting success compared to those receiving a 21-mg nicotine patch with increasing doses of placebo patch. Methods This is a multicenter, pragmatic, two-arm, placebo-controlled, block randomized controlled trial. We will recruit participants who smoke at least 10 cigarettes daily and are interested in making a quit attempt. After 2 weeks of usual treatment with a 21-mg patch, participants who fail to quit smoking (target n = 400) will be randomized to receive escalating doses of a nicotine patch vs matching placebo patches for an additional 10 weeks or up to a maximum dose of 84 mg per day. Those who stop smoking during the first 2 weeks of usual treatment will continue with 21 mg patch treatment for 10 weeks and will form an additional comparison arm. In addition to the medication, participants will receive brief behavioral counseling at each study visit. The primary outcome will be biochemically confirmed continuous abstinence from smoking during the last 4 weeks of treatment (weeks 9 to 12). Discussion Research evidence supporting the effectiveness of personalized doses of nicotine replacement therapy could change current practice in a variety of healthcare settings. Given the evidence that quitting smoking at any age diminishes the risk of tobacco-related morbidity and mortality, even small increases in absolute quit rates can have a substantial population-level impact on reducing smoking-related disease, mortality rates, and associated healthcare costs. Trial registration ClinicalTrials.gov, NCT03000387. Registered on 22 December 2016.
Collapse
Affiliation(s)
- Laurie Zawertailo
- Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada
| | - Christian S Hendershot
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes St., Toronto, Ontario, M6J 1H4, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.,Department of Psychology, University of Toronto, 100 St. George St., Toronto, Ontario, M5S 3G3, Canada
| | - Rachel F Tyndale
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes St., Toronto, Ontario, M6J 1H4, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes St., Toronto, Ontario, M6J 1H4, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Andriy V Samokhvalov
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.,Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, 100 Stokes St., Toronto, Ontario, M6J 1H4, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell St, Toronto, Ontario, M5S 2S1, Canada.,Department of Psychiatry, McMaster University, 100 West 5th, Hamilton, Ontario, L8N 3K7, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, 155 College St., Toronto, Ontario, M5T 3M7, Canada.,The Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 250 Yonge St., Toronto, Ontario, M5G 1B1, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, Ontario, K1Y 4W7, Canada
| | - Robert D Reid
- University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, Ontario, K1Y 4W7, Canada
| | - Peter Selby
- Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada. .,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes St., Toronto, Ontario, M6J 1H4, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada. .,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, Ontario, M5G 1V7, Canada. .,Dalla Lana School of Public Health, 155 College St., Toronto, Ontario, M5T 3M7, Canada.
| |
Collapse
|
12
|
Addressing the disease burden of asthma and chronic bronchitis due to tobacco consumption: a study of Kanpur, India. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01040-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Gao W, Sanna M, Chuluunbaatar E, Tsai MK, Levy DT, Wen CP. Are e-cigarettes reviving the popularity of conventional smoking among Taiwanese male adolescents? A time-trend population-based analysis for 2004-2017. Tob Control 2020; 30:132-136. [PMID: 32234845 DOI: 10.1136/tobaccocontrol-2019-055310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In Taiwan, national tobacco use surveys show that e-cigarette use has increased since 2014 among youth, while, at the same time, conventional cigarette smoking has continuously decreased. The purpose of this study is to examine whether the increased popularity of e-cigarettes has undermined this favourable declining trend for cigarette smoking. METHODS We examined conventional cigarette and e-cigarette prevalence among male high school students (aged 16-18 years) and adults from 2004 to 2017, using data from cross-sectional nationally representative surveys. Applying interrupted time series analysis, we assessed whether there was a change in trend in 2014, when e-cigarette use started to gain popularity from long-term trends in prior years (2004-2013). RESULTS E-cigarette use prevalence increased from 2.5% in 2014 to 6.4% in 2017 among male high school students but was negligible among male adults, declining from 1.4% in 2015 to 0.8% in 2017. The annual relative decline in the cigarette smoking rate after e-cigarettes started to gain popularity was greater (-10%) than the long-term trend (-2%) among high school students. Among adults, the change in trend over time after e-cigarettes started to gain popularity was not significant (ie, not significantly different from 0). CONCLUSIONS The increased popularity of e-cigarettes since 2014 is associated with a greater decline in youth smoking, compared with previous years. On the contrary, e-cigarette use has remained very low among Taiwanese male adults and no additional impact on the conventional smoking trend is found.
Collapse
Affiliation(s)
- Wayne Gao
- Master's Program in Global Health and Development, Taipei Medical University, Taipei City, Taiwan
| | - Mattia Sanna
- Master's Program in Global Health and Development, Taipei Medical University, Taipei City, Taiwan
| | - Enkhzaya Chuluunbaatar
- Master's Program in Global Health and Development, Taipei Medical University, Taipei City, Taiwan
| | - Min-Kuang Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - David T Levy
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Chi Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.,China Medical University Hospital, Taichung City, Taiwan
| |
Collapse
|
15
|
Nagler EM, Aghi M, Rathore A, Lando H, Pednekar MS, Gupta PC, Stoddard AM, Kenwood C, Penningroth B, Sinha DN, Sorensen G. Factors associated with successful tobacco use cessation among teachers in Bihar state, India: a mixed-method study. HEALTH EDUCATION RESEARCH 2020; 35:60-73. [PMID: 31999824 PMCID: PMC6991618 DOI: 10.1093/her/cyz035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
Although tobacco use is declining in several countries including India (dropping from 35% in 2009-10 to 29% 2016-17 among adults)-it still poses a huge burden on India, as the world's second largest consumer of tobacco products. In Bihar state, with a prevalence of 25%, the Bihar School Teachers Study (BSTS) successfully enlisted teachers as role models for encouraging quitting and changing social norms pertaining to tobacco. The study used a mixed-methods approach to identify factors associated with teachers' quitting. Qualitative data were collected through focus groups with teachers and school principals. Quantitative data were collected through a written survey administered to school personnel post-intervention. Key findings from focus groups were that teachers and principals quit using tobacco and promoted cessation because they wanted to model positive behaviors; specific information about tobacco's harms aided cessation; and the BSTS intervention facilitated a school environment that supported quitting. Survey results indicated teachers who reported knowing people who quit using tobacco in the prior year were far more likely to quit as were teachers who reported that their school's tobacco policy was completely enforced. The combination of qualitative and quantitative data yielded important insights with strong implications for future interventions.
Collapse
Affiliation(s)
- E M Nagler
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Social and Behavioral Sciences Department, Harvard T.H. Chan School of Public Health, 450 Brookline Avenue, LW722 Boston, MA 02115, USA
| | - M Aghi
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra 400701, India
| | - A Rathore
- Welobaby Jaipur, Rajasthan 302039, India
| | - H Lando
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55454, USA
| | - M S Pednekar
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra 400701, India
| | - P C Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra 400701, India
| | - A M Stoddard
- Biostatistical Consultant, Pelham, MA 01002, USA
| | - C Kenwood
- Veristat, LLC, Southborough, MA 01772, USA
| | | | - D N Sinha
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, Maharashtra 400701, India
| | - G Sorensen
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Social and Behavioral Sciences Department, Harvard T.H. Chan School of Public Health, 450 Brookline Avenue, LW722 Boston, MA 02115, USA
| |
Collapse
|
16
|
Ussher MH, Faulkner GEJ, Angus K, Hartmann‐Boyce J, Taylor AH. Exercise interventions for smoking cessation. Cochrane Database Syst Rev 2019; 2019:CD002295. [PMID: 31684691 PMCID: PMC6819982 DOI: 10.1002/14651858.cd002295.pub6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Taking regular exercise, whether cardiovascular-type exercise or resistance exercise, may help people to give up smoking, particularly by reducing cigarette withdrawal symptoms and cravings, and by helping to manage weight gain. OBJECTIVES To determine the effectiveness of exercise-based interventions alone, or combined with a smoking cessation programme, for achieving long-term smoking cessation, compared with a smoking cessation intervention alone or other non-exercise intervention. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register for studies, using the term 'exercise' or 'physical activity' in the title, abstract or keywords. The date of the most recent search was May 2019. SELECTION CRITERIA We included randomised controlled trials that compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme alone or another non-exercise control group. Trials were required to recruit smokers wishing to quit or recent quitters, to assess abstinence as an outcome and have follow-up of at least six months. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison, as either smoking cessation or relapse prevention. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. MAIN RESULTS We identified 24 eligible trials with a total of 7279 adult participants randomised. Two studies focused on relapse prevention among smokers who had recently stopped smoking, and the remaining 22 studies were concerned with smoking cessation for smokers who wished to quit. Eleven studies were with women only and one with men only. Most studies recruited fairly inactive people. Most of the trials employed supervised, group-based cardiovascular-type exercise supplemented by a home-based exercise programme and combined with a multi-session cognitive behavioural smoking cessation programme. The comparator in most cases was a multi-session cognitive behavioural smoking cessation programme alone. Overall, we judged two studies to be at low risk of bias, 11 at high risk of bias, and 11 at unclear risk of bias. Among the 21 studies analysed, we found low-certainty evidence, limited by potential publication bias and by imprecision, comparing the effect of exercise plus smoking cessation support with smoking cessation support alone on smoking cessation outcomes (RR 1.08, 95% CI 0.96 to 1.22; I2 = 0%; 6607 participants). We excluded one study from this analysis as smoking abstinence rates for the study groups were not reported. There was no evidence of subgroup differences according to the type of exercise promoted; the subgroups considered were: cardiovascular-type exercise alone (17 studies), resistance training alone (one study), combined cardiovascular-type and resistance exercise (one study) and type of exercise not specified (two studies). The results were not significantly altered when we excluded trials with high risk of bias, or those with special populations, or those where smoking cessation intervention support was not matched between the intervention and control arms. Among the two relapse prevention studies, we found very low-certainty evidence, limited by risk of bias and imprecision, that adding exercise to relapse prevention did not improve long-term abstinence compared with relapse prevention alone (RR 0.98, 95% CI 0.65 to 1.47; I2 = 0%; 453 participants). AUTHORS' CONCLUSIONS There is no evidence that adding exercise to smoking cessation support improves abstinence compared with support alone, but the evidence is insufficient to assess whether there is a modest benefit. Estimates of treatment effect were of low or very low certainty, because of concerns about bias in the trials, imprecision and publication bias. Consequently, future trials may change these conclusions.
Collapse
Affiliation(s)
- Michael H Ussher
- St George's, University of LondonPopulation Health Research InstituteCranmer TerraceLondonUKSW17 0RE
- University of StirlingInstitute for Social MarketingStirlingUK
| | - Guy E J Faulkner
- University of British ColumbiaSchool of Kinesiology2146 Health Sciences MallVancouverCanadaV6T 1Z3
| | - Kathryn Angus
- University of StirlingInstitute for Social MarketingStirlingUK
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Adrian H Taylor
- University of PlymouthFaculty of Health: Medicine, Dentistry and Human SciencesRoom N32, ITTC Building, Tamar Science ParkDerrifordPlymouthUKPL6 8BX
| | | |
Collapse
|
17
|
Brown J, Kyriacou C, Pickett E, Edwards K, Joshi H, Stewart N, Melville A, Johnson M, Flint J, Bartley A, Rodger A, Lipman M. Systematic identification and referral of smokers attending HIV ambulatory care highlights the failure of current service provision in an at-risk population. BMJ Open Respir Res 2019; 6:e000395. [PMID: 31673360 PMCID: PMC6797406 DOI: 10.1136/bmjresp-2018-000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction People living with HIV (PLWH) are more likely to smoke than the general population and are at greater risk of smoking-related illness. Healthcare services need to address this burden of preventable disease. Methods We evaluated the impact of a brief intervention that asked service users about smoking when they attended for ambulatory HIV care in London, UK, and offered referral to smoking cessation. Results Overall, 1548 HIV-positive individuals were asked about their smoking status over a 12-month period. Of this group, 385 (25%) reported that they were current smokers, 372 (97%) were offered referral to smoking cessation services and 154 (40%) accepted this. We established an outcome of referral for 114 (74%) individuals. A total of 36 (10% of smokers) attended stop smoking clinics and 16 (4%) individuals were recorded as having quit smoking. Discussion The simple intervention of asking PLWH about tobacco smoking and offering referral to smoking cessation services rapidly identified current smokers, 40% of whom accepted referral to smoking cessation services. This highlights the importance of promoting behaviour and lifestyle changes with every contact with health services. However, a large proportion of those referred were either not seen in local services or the outcome of referral could not be ascertained. If the risk of smoking-related morbidity among PLWH is to be reduced, more sustainable referral pathways and ways of improving uptake of smoking cessation services must be developed.
Collapse
Affiliation(s)
- James Brown
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | | | - Elisha Pickett
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Kelly Edwards
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Hemal Joshi
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Nafeesah Stewart
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Melville
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Margaret Johnson
- Respiratory and HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Jan Flint
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Angela Bartley
- Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Alison Rodger
- Institute for Global Health, University College London Medical School, London, UK
| | - Marc Lipman
- UCL Respiratory, University College London, London, UK
| |
Collapse
|
18
|
Lindson N, Klemperer E, Hong B, Ordóñez‐Mena JM, Aveyard P. Smoking reduction interventions for smoking cessation. Cochrane Database Syst Rev 2019; 9:CD013183. [PMID: 31565800 PMCID: PMC6953262 DOI: 10.1002/14651858.cd013183.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The standard way most people are advised to stop smoking is by quitting abruptly on a designated quit day. However, many people who smoke have tried to quit many times and may like to try an alternative method. Reducing smoking behaviour before quitting could be an alternative approach to cessation. However, before this method can be recommended it is important to ensure that abrupt quitting is not more effective than reducing to quit, and to determine whether there are ways to optimise reduction methods to increase the chances of cessation. OBJECTIVES To assess the effect of reduction-to-quit interventions on long-term smoking cessation. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, Embase and PsycINFO for studies, using the terms: cold turkey, schedul*, cut* down, cut-down, gradual*, abrupt*, fading, reduc*, taper*, controlled smoking and smoking reduction. We also searched trial registries to identify unpublished studies. Date of the most recent search: 29 October 2018. SELECTION CRITERIA Randomised controlled trials in which people who smoked were advised to reduce their smoking consumption before quitting smoking altogether in at least one trial arm. This advice could be delivered using self-help materials or behavioural support, and provided alongside smoking cessation pharmacotherapies or not. We excluded trials that did not assess cessation as an outcome, with follow-up of less than six months, where participants spontaneously reduced without being advised to do so, where the goal of reduction was not to quit altogether, or where participants were advised to switch to cigarettes with lower nicotine levels without reducing the amount of cigarettes smoked or the length of time spent smoking. We also excluded trials carried out in pregnant women. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison (no smoking cessation treatment, abrupt quitting interventions, and other reduction-to-quit interventions) and carried out meta-analyses where appropriate, using a Mantel-Haenszel random-effects model. We also extracted data on quit attempts, pre-quit smoking reduction, adverse events (AEs), serious adverse events (SAEs) and nicotine withdrawal symptoms, and meta-analysed these where sufficient data were available. MAIN RESULTS We identified 51 trials with 22,509 participants. Most recruited adults from the community using media or local advertising. People enrolled in the studies typically smoked an average of 23 cigarettes a day. We judged 18 of the studies to be at high risk of bias, but restricting the analysis only to the five studies at low or to the 28 studies at unclear risk of bias did not significantly alter results.We identified very low-certainty evidence, limited by risk of bias, inconsistency and imprecision, comparing the effect of reduction-to-quit interventions with no treatment on cessation rates (RR 1.74, 95% CI 0.90 to 3.38; I2 = 45%; 6 studies, 1599 participants). However, when comparing reduction-to-quit interventions with abrupt quitting (standard care) we found evidence that neither approach resulted in superior quit rates (RR 1. 01, 95% CI 0.87 to 1.17; I2 = 29%; 22 studies, 9219 participants). We judged this estimate to be of moderate certainty, due to imprecision. Subgroup analysis provided some evidence (P = 0.01, I2 = 77%) that reduction-to-quit interventions may result in more favourable quit rates than abrupt quitting if varenicline is used as a reduction aid. Our analysis comparing reduction using pharmacotherapy with reduction alone found low-certainty evidence, limited by inconsistency and imprecision, that reduction aided by pharmacotherapy resulted in higher quit rates (RR 1. 68, 95% CI 1.09 to 2.58; I2 = 78%; 11 studies, 8636 participants). However, a significant subgroup analysis (P < 0.001, I2 = 80% for subgroup differences) suggests that this may only be true when fast-acting NRT or varenicline are used (both moderate-certainty evidence) and not when nicotine patch, combination NRT or bupropion are used as an aid (all low- or very low-quality evidence). More evidence is likely to change the interpretation of the latter effects.Although there was some evidence from within-study comparisons that behavioural support for reduction to quit resulted in higher quit rates than self-help resources alone, the relative efficacy of various other characteristics of reduction-to-quit interventions investigated through within- and between-study comparisons did not provide any evidence that they enhanced the success of reduction-to-quit interventions. Pre-quit AEs, SAEs and nicotine withdrawal symptoms were measured variably and infrequently across studies. There was some evidence that AEs occurred more frequently in studies that compared reduction using pharmacotherapy versus no pharmacotherapy; however, the AEs reported were mild and usual symptoms associated with NRT use. There was no clear evidence that the number of people reporting SAEs, or changes in withdrawal symptoms, differed between trial arms. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that neither reduction-to-quit nor abrupt quitting interventions result in superior long-term quit rates when compared with one another. Evidence comparing the efficacy of reduction-to-quit interventions with no treatment was inconclusive and of low certainty. There is also low-certainty evidence to suggest that reduction-to-quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast-acting NRT or varenicline (moderate-certainty evidence). Evidence for any adverse effects of reduction-to-quit interventions was sparse, but available data suggested no excess of pre-quit SAEs or withdrawal symptoms. We downgraded the evidence across comparisons due to risk of bias, inconsistency and imprecision. Future research should aim to match any additional components of multicomponent reduction-to-quit interventions across study arms, so that the effect of reduction can be isolated. In particular, well-conducted, adequately-powered studies should focus on investigating the most effective features of reduction-to-quit interventions to maximise cessation rates.
Collapse
Affiliation(s)
- Nicola Lindson
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Elias Klemperer
- University of VermontDepartments of Psychological Sciences & Psychiatry1 S Prospect Street, Mail Stop 482, OH4BurlingtonVTUSA05405
| | - Bosun Hong
- Birmingham Dental HospitalOral Surgery Department5 Mill Pool WayBirminghamUKB5 7EG
| | - José M Ordóñez‐Mena
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Paul Aveyard
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | | |
Collapse
|
19
|
Lindson N, Thompson TP, Ferrey A, Lambert JD, Aveyard P. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2019; 7:CD006936. [PMID: 31425622 PMCID: PMC6699669 DOI: 10.1002/14651858.cd006936.pub4] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help people to a make a successful attempt to stop smoking. OBJECTIVES To evaluate the efficacy of MI for smoking cessation compared with no treatment, in addition to another form of smoking cessation treatment, and compared with other types of smoking cessation treatment. We also investigated whether more intensive MI is more effective than less intensive MI for smoking cessation. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register for studies using the term motivat* NEAR2 (interview* OR enhanc* OR session* OR counsel* OR practi* OR behav*) in the title or abstract, or motivation* as a keyword. We also searched trial registries to identify unpublished studies. Date of the most recent search: August 2018. SELECTION CRITERIA Randomised controlled trials in which MI or its variants were offered to smokers to assist smoking cessation. We excluded trials that did not assess cessation as an outcome, with follow-up less than six months, and with additional non-MI intervention components not matched between arms. We excluded trials in pregnant women as these are covered elsewhere. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RR) and 95% confidence intervals (CI) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. We extracted data on mental health outcomes and quality of life and summarised these narratively. MAIN RESULTS We identified 37 eligible studies involving over 15,000 participants who smoked tobacco. The majority of studies recruited participants with particular characteristics, often from groups of people who are less likely to seek support to stop smoking than the general population. Although a few studies recruited participants who intended to stop smoking soon or had no intentions to quit, most recruited a population without regard to their intention to quit. MI was conducted in one to 12 sessions, with the total duration of MI ranging from five to 315 minutes across studies. We judged four of the 37 studies to be at low risk of bias, and 11 to be at high risk, but restricting the analysis only to those studies at low or unclear risk did not significantly alter results, apart from in one case - our analysis comparing higher to lower intensity MI.We found low-certainty evidence, limited by risk of bias and imprecision, comparing the effect of MI to no treatment for smoking cessation (RR = 0.84, 95% CI 0.63 to 1.12; I2 = 0%; adjusted N = 684). One study was excluded from this analysis as the participants recruited (incarcerated men) were not comparable to the other participants included in the analysis, resulting in substantial statistical heterogeneity when all studies were pooled (I2 = 87%). Enhancing existing smoking cessation support with additional MI, compared with existing support alone, gave an RR of 1.07 (95% CI 0.85 to 1.36; adjusted N = 4167; I2 = 47%), and MI compared with other forms of smoking cessation support gave an RR of 1.24 (95% CI 0.91 to 1.69; I2 = 54%; N = 5192). We judged both of these estimates to be of low certainty due to heterogeneity and imprecision. Low-certainty evidence detected a benefit of higher intensity MI when compared with lower intensity MI (RR 1.23, 95% CI 1.11 to 1.37; adjusted N = 5620; I2 = 0%). The evidence was limited because three of the five studies in this comparison were at risk of bias. Excluding them gave an RR of 1.00 (95% CI 0.65 to 1.54; I2 = n/a; N = 482), changing the interpretation of the results.Mental health and quality of life outcomes were reported in only one study, providing little evidence on whether MI improves mental well-being. AUTHORS' CONCLUSIONS There is insufficient evidence to show whether or not MI helps people to stop smoking compared with no intervention, as an addition to other types of behavioural support for smoking cessation, or compared with other types of behavioural support for smoking cessation. It is also unclear whether more intensive MI is more effective than less intensive MI. All estimates of treatment effect were of low certainty because of concerns about bias in the trials, imprecision and inconsistency. Consequently, future trials are likely to change these conclusions. There is almost no evidence on whether MI for smoking cessation improves mental well-being.
Collapse
Affiliation(s)
- Nicola Lindson
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Tom P Thompson
- University of PlymouthFaculty of Medicine and DentistryPlymouthDevonUK
| | - Anne Ferrey
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | | | - Paul Aveyard
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | | |
Collapse
|
20
|
Lindson N, Chepkin SC, Ye W, Fanshawe TR, Bullen C, Hartmann‐Boyce J. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2019; 4:CD013308. [PMID: 30997928 PMCID: PMC6470854 DOI: 10.1002/14651858.cd013308] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nicotine replacement therapy (NRT) aims to replace nicotine from cigarettes to ease the transition from cigarette smoking to abstinence. It works by reducing the intensity of craving and withdrawal symptoms. Although there is clear evidence that NRT used after smoking cessation is effective, it is unclear whether higher doses, longer durations of treatment, or using NRT before cessation add to its effectiveness. OBJECTIVES To determine the effectiveness and safety of different forms, deliveries, doses, durations and schedules of NRT, for achieving long-term smoking cessation, compared to one another. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group trials register, and trial registries for papers mentioning NRT in the title, abstract or keywords. Date of most recent search: April 2018. SELECTION CRITERIA Randomized trials in people motivated to quit, comparing one type of NRT use with another. We excluded trials that did not assess cessation as an outcome, with follow-up less than six months, and with additional intervention components not matched between arms. Trials comparing NRT to control, and trials comparing NRT to other pharmacotherapies, are covered elsewhere. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Smoking abstinence was measured after at least six months, using the most rigorous definition available. We extracted data on cardiac adverse events (AEs), serious adverse events (SAEs), and study withdrawals due to treatment. We calculated the risk ratio (RR) and the 95% confidence interval (CI) for each outcome for each study, where possible. We grouped eligible studies according to the type of comparison. We carried out meta-analyses where appropriate, using a Mantel-Haenszel fixed-effect model. MAIN RESULTS We identified 63 trials with 41,509 participants. Most recruited adults either from the community or from healthcare clinics. People enrolled in the studies typically smoked at least 15 cigarettes a day. We judged 24 of the 63 studies to be at high risk of bias, but restricting the analysis only to those studies at low or unclear risk of bias did not significantly alter results, apart from in the case of the preloading comparison. There is high-certainty evidence that combination NRT (fast-acting form + patch) results in higher long-term quit rates than single form (RR 1.25, 95% CI 1.15 to 1.36, 14 studies, 11,356 participants; I2 = 4%). Moderate-certainty evidence, limited by imprecision, indicates that 42/44 mg are as effective as 21/22 mg (24-hour) patches (RR 1.09, 95% CI 0.93 to 1.29, 5 studies, 1655 participants; I2 = 38%), and that 21 mg are more effective than 14 mg (24-hour) patches (RR 1.48, 95% CI 1.06 to 2.08, 1 study, 537 participants). Moderate-certainty evidence (again limited by imprecision) also suggests a benefit of 25 mg over 15 mg (16-hour) patches, but the lower limit of the CI encompassed no difference (RR 1.19, 95% CI 1.00 to 1.41, 3 studies, 3446 participants; I2 = 0%). Five studies comparing 4 mg gum to 2 mg gum found a benefit of the higher dose (RR 1.43, 95% CI 1.12 to 1.83, 5 studies, 856 participants; I2 = 63%); however, results of a subgroup analysis suggest that only smokers who are highly dependent may benefit. Nine studies tested the effect of using NRT prior to quit day (preloading) in comparison to using it from quit day onward; there was moderate-certainty evidence, limited by risk of bias, of a favourable effect of preloading on abstinence (RR 1.25, 95% CI 1.08 to 1.44, 9 studies, 4395 participants; I2 = 0%). High-certainty evidence from eight studies suggests that using either a form of fast-acting NRT or a nicotine patch results in similar long-term quit rates (RR 0.90, 95% CI 0.77 to 1.05, 8 studies, 3319 participants; I2 = 0%). We found no evidence of an effect of duration of nicotine patch use (low-certainty evidence); 16-hour versus 24-hour daily patch use; duration of combination NRT use (low- and very low-certainty evidence); tapering of patch dose versus abrupt patch cessation; fast-acting NRT type (very low-certainty evidence); duration of nicotine gum use; ad lib versus fixed dosing of fast-acting NRT; free versus purchased NRT; length of provision of free NRT; ceasing versus continuing patch use on lapse; and participant- versus clinician-selected NRT. However, in most cases these findings are based on very low- or low-certainty evidence, and are the findings from single studies.AEs, SAEs and withdrawals due to treatment were all measured variably and infrequently across studies, resulting in low- or very low-certainty evidence for all comparisons. Most comparisons found no evidence of an effect on cardiac AEs, SAEs or withdrawals. Rates of these were low overall. Significantly more withdrawals due to treatment were reported in participants using nasal spray in comparison to patch in one trial (RR 3.47, 95% CI 1.15 to 10.46, 922 participants; very low certainty) and in participants using 42/44 mg patches in comparison to 21/22 mg patches across two trials (RR 4.99, 95% CI 1.60 to 15.50, 2 studies, 544 participants; I2 = 0%; low certainty). AUTHORS' CONCLUSIONS There is high-certainty evidence that using combination NRT versus single-form NRT, and 4 mg versus 2 mg nicotine gum, can increase the chances of successfully stopping smoking. For patch dose comparisons, evidence was of moderate certainty, due to imprecision. Twenty-one mg patches resulted in higher quit rates than 14 mg (24-hour) patches, and using 25 mg patches resulted in higher quit rates than using 15 mg (16-hour) patches, although in the latter case the CI included one. There was no clear evidence of superiority for 42/44 mg over 21/22 mg (24-hour) patches. Using a fast-acting form of NRT, such as gum or lozenge, resulted in similar quit rates to nicotine patches. There is moderate-certainty evidence that using NRT prior to quitting may improve quit rates versus using it from quit date only; however, further research is needed to ensure the robustness of this finding. Evidence for the comparative safety and tolerability of different types of NRT use is of low and very low certainty. New studies should ensure that AEs, SAEs and withdrawals due to treatment are both measured and reported.
Collapse
Affiliation(s)
- Nicola Lindson
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | | | - Weiyu Ye
- University of OxfordOxford University Clinical Academic Graduate SchoolOxfordUK
| | - Thomas R Fanshawe
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Chris Bullen
- University of AucklandNational Institute for Health InnovationPrivate Bag 92019Auckland Mail CentreAucklandNew Zealand1142
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | | |
Collapse
|
21
|
Affiliation(s)
- Nicola Lindson
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford Oxfordshire UK OX2 6GG
| | - Elias Klemperer
- University of Vermont; Departments of Psychological Sciences & Psychiatry; 1 S Prospect Street, Mail Stop 482, OH4 Burlington VT USA 05405
| | - Paul Aveyard
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford Oxfordshire UK OX2 6GG
| |
Collapse
|
22
|
Cox S, Dawkins L. Global and local perspectives on tobacco harm reduction: what are the issues and where do we go from here? Harm Reduct J 2018; 15:32. [PMID: 29933744 PMCID: PMC6013869 DOI: 10.1186/s12954-018-0239-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sharon Cox
- Centre for Addictive Behaviours Research, School of Applied Sciences London South Bank University, 103 Borough Road, London, SE1 0AA, UK.
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences London South Bank University, 103 Borough Road, London, SE1 0AA, UK
| |
Collapse
|
23
|
Casetta B, Videla AJ, Bardach A, Morello P, Soto N, Lee K, Camacho PA, Hermoza Moquillaza RV, Ciapponi A. Association Between Cigarette Smoking Prevalence and Income Level: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2018; 19:1401-1407. [PMID: 27679607 DOI: 10.1093/ntr/ntw266] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 09/26/2016] [Indexed: 12/19/2022]
Abstract
Introduction Previous evidence linked low socioeconomic status with higher smoking prevalence. Our objective was to assess the strength of this association in the world population, updating a previous work. Methods Systematic review and meta-analysis of observational studies. Subgroup analyses included continents, WHO regions, country mortality levels, gender, age, risk of bias, and study publication date. Independent reviewers selected studies, assessed potential bias and extracted data. We searched MEDLINE, EMBASE, CENTRAL, SOCINDEX, AFRICAN INDEX MEDICUS, and LILACS, and other sources from 1989 to 2013 reporting direct measurements of income and current cigarette smoking. Results We retrieved 13,583 articles and included 93 for meta-analysis. Median smoking prevalence was 17.8% (range 3-70%). Lower income was consistently associated with higher smoking prevalence (odds ratio [OR]: 1.45; 95% confidence interval [CI]: 1.35-1.56). This association was statistically significant in the subgroup analysis by WHO regions for the Americas (OR: 1.54; 95% CI: 1.42-1.68), South East Asia (OR: 1.53; 95% CI: 1.10-2.00), Europe (OR: 1.45; 95% CI: 1.29-1.63), and Western Pacific (OR: 1.32; 95% CI: 1.02-1.72), and in studies conducted during 1990s (OR: 1.42; 95% CI: 1.24-1.62) and 2000s (OR: 1.48; 95%CI: 1.30-1.64). Likewise, it was noted in low-mortality countries (OR: 1.48; 95% CI: 1.37-1.60) and for both genders. Prevalence was highest in the lowest income levels compared to the middle (OR: 1.69; 95% CI: 1.49-1.92), followed by the middle level compared to the highest (OR: 1.31; 95% CI: 1.20-1.43). Conclusions Our results show that current cigarette smoking was significantly associated with lower income worldwide and across subgroups, suggesting a dose-response relationship. Implications This unique updated systematic review shows a consistent inverse dose-response relationship between cigarette smoking and income level, present among most geographical areas and country characteristics. Public health measures should take into account this potential inequity and consider special efforts directed to disadvantaged populations.
Collapse
Affiliation(s)
- Brunilda Casetta
- IUC-Instituto Universitario CEMIC (Centro de Educación Médica e Investigaciones Clínicas), Buenos Aires, Argentina.,Direction of Non-Communicable Diseases, Ministry of Health, Buenos Aires, Argentina
| | - Alejandro J Videla
- IUC-Instituto Universitario CEMIC (Centro de Educación Médica e Investigaciones Clínicas), Buenos Aires, Argentina.,Department of Medicine, Hospital Universitario Austral, Facultad de Ciencias Biomédicas, Universidad Austral, Pilar, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS) Centro de Investigación de Epidemiología y Salud Pública (CIESP), unidad ejecutora Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Paola Morello
- Instituto de Efectividad Clínica y Sanitaria (IECS) Centro de Investigación de Epidemiología y Salud Pública (CIESP), unidad ejecutora Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Natalie Soto
- Instituto de Efectividad Clínica y Sanitaria (IECS) Centro de Investigación de Epidemiología y Salud Pública (CIESP), unidad ejecutora Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Kelly Lee
- Department of Health Economics, Faculty of Health, Deakin University, Melbourne, Australia
| | - Paul Anthony Camacho
- Dirección de investigaciones, Fundación Oftalmológica de Santander, Bucaramanga, Colombia
| | | | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS) Centro de Investigación de Epidemiología y Salud Pública (CIESP), unidad ejecutora Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| |
Collapse
|
24
|
Hakim S, Chowdhury MAB, Uddin MJ. Correlates of attempting to quit smoking among adults in Bangladesh. Addict Behav Rep 2018; 8:1-7. [PMID: 30062100 PMCID: PMC6062856 DOI: 10.1016/j.abrep.2018.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/21/2018] [Accepted: 04/21/2018] [Indexed: 11/29/2022] Open
Abstract
Background Quit attempts are very essential in population-based smoking cessation. Little is known about the correlates of making a quit attempt of smoking in Bangladesh. We aimed to examine correlates of making a quit attempt of smoking among adults in Bangladesh. Methods We used data from the 2009 Global Adult Tobacco Survey, Bangladesh. A total of 2217 adult current smokers (2141 males and 76 females) aged 15 years and older who participated in the survey were included. We compared socio-demographic, behavioral, motivational, knowledge and attitudes towards smoking, quitting methods utilized, use of social media to quit smoking, and environmental characteristics of current smokers who made an attempt to quit with those who made no quit attempt during the previous 12 months of the survey. We applied multivariable logistic regression models for analyzing the data. Results Among the 2217 current smokers, 1058 (47.72%) made attempt to quit. We found respondents who smoked their first cigarette within 6 to 30 min of waking up were more likely to make an attempt to quit than those who smoked their first cigarette within 5 min of waking. Moreover, among daily current smokers who smoked 10–19 manufactured cigarettes per day were less likely to make a quit attempt. We also found intention to quit smoking, smoking rules inside the home, and exposure to anti-smoking advertisements as significant correlates of making a quit attempt of smoking among adults in Bangladesh. Conclusions Policymakers should consider our findings when implementing tobacco control programs in Bangladesh. Quit attempts are very essential in population-based smoking cessation. Among the 2233 current smokers, 1058 individuals attempted to quit smoking. Smokers who don't smoke quickly after waking were more likely to make quit attempt. Smokers who lived in a smoke-free home were also more likely to make quit attempt.
Collapse
Affiliation(s)
- Shariful Hakim
- Department of Statistics, Shahjalal University of Science & Technology, Sylhet 3114, Bangladesh
| | | | - Md Jamal Uddin
- Department of Statistics, Shahjalal University of Science & Technology, Sylhet 3114, Bangladesh
| |
Collapse
|
25
|
Glover M, Breier BH, Bauld L. Could Vaping be a New Weapon in the Battle of the Bulge? Nicotine Tob Res 2017; 19:1536-1540. [PMID: 27798086 DOI: 10.1093/ntr/ntw278] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 10/05/2016] [Indexed: 02/11/2024]
Abstract
IMPLICATIONS Obesity is set to overtake tobacco smoking in many countries as the primary cause of several high-cost diseases. Tobacco smoking mitigates weight gain through nicotine's effect on the brain and metabolism. Smoking, however, is associated with many illnesses and premature death and appropriately has been discouraged leading to declining prevalence rates. This article explores the emerging perception that vaping electronic cigarettes with nicotine and flavors could deliver similar appetite and weight control effects as smoking. The potential to reduce risks associated with excess weight deserves exploration. An initial research agenda is suggested.
Collapse
Affiliation(s)
- Marewa Glover
- School of Public Health, College of Health, Massey University, North Shore, Auckland, New Zealand
| | - Bernhard H Breier
- Massey Institute of Food Science and Technology, College of Health, Massey University, North Shore, Auckland, New Zealand
| | - Linda Bauld
- UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| |
Collapse
|
26
|
Doucet M. The costs and benefits of a cigarette ban. JOURNAL OF MEDICAL ETHICS 2017; 43:411-412. [PMID: 28258070 DOI: 10.1136/medethics-2017-104172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/06/2017] [Indexed: 06/06/2023]
Abstract
The death toll from tobacco is staggering: it might contribute to one billion premature deaths over the course of the 21st century. In 'The case for banning cigarettes', Kalle Grill and Kristin Voigt argue that the well-being and equality benefits of a complete ban on cigarettes more than justify the restrictions on autonomy that such a ban would impose. Their argument depends on two crucial simplifications: an assumption that the ban would be effective and the restriction of the analysis to a comparison with the status quo, rather than a broader range of policy options. I argue that despite the authors' claims, these two simplifications make it impossible for their argument to 'bring into focus the fundamental normative issues' surrounding a possible cigarette ban, since they dramatically overstate the benefits and obscure the most significant costs of such a ban.
Collapse
|
27
|
Pinto E, Cruz M, Ramos P, Santos A, Almeida A. Metals transfer from tobacco to cigarette smoke: Evidences in smokers' lung tissue. JOURNAL OF HAZARDOUS MATERIALS 2017; 325:31-35. [PMID: 27914289 DOI: 10.1016/j.jhazmat.2016.11.069] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 06/06/2023]
Abstract
Tobacco use kills millions of people every year around the world. The current level of 11 metals in tobacco was determined and their transfer rate to cigarette smoke was calculated as the difference between the total metal content in cigarettes and the amount present in its ashes. The metals content was also determined in the lung tissue of smokers and non-smokers in order to evaluate the marks that smoking leaves in this tissue. Metals content in tobacco ranged from less than 1μg/g (Co, Cd, Pb, As and Tl) to several hundreds of μg/g (Al, Mn and Ba). The highest transfer rate from tobacco to cigarette smoke was found for Tl (85-92%) and Cd (81-90%), followed by Pb (46-60%) and As (33-44%). Significantly higher levels of As, Cd and Pb were found in the lung tissue of smokers compared to non-smokers, showing that smoking results in an increase of these metals in the lungs and that they contribute to the carcinogenic potential of cigarette smoke. This study presents important data on current metals content in tobacco and its transference to cigarette smoke and provides evidence of their accumulation in smokers' lung tissue.
Collapse
Affiliation(s)
- Edgar Pinto
- LAQV/REQUIMTE, Department of Chemical Sciences, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto, Porto, Portugal; Department of Environmental Health, Polytechnic Institute of Porto, School of Health, CISA/Research Center in Environment and Health, Porto, Portugal.
| | - Mariana Cruz
- LAQV/REQUIMTE, Department of Chemical Sciences, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Patrícia Ramos
- LAQV/REQUIMTE, Department of Chemical Sciences, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Agostinho Santos
- National Institute of Legal Medicine and Forensic Sciences-North Branch, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Agostinho Almeida
- LAQV/REQUIMTE, Department of Chemical Sciences, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto, Porto, Portugal
| |
Collapse
|
28
|
Gilbert H, Sutton S, Morris R, Petersen I, Galton S, Wu Q, Parrott S, Nazareth I. Effectiveness of personalised risk information and taster sessions to increase the uptake of smoking cessation services (Start2quit): a randomised controlled trial. Lancet 2017; 389:823-833. [PMID: 28129989 PMCID: PMC5357975 DOI: 10.1016/s0140-6736(16)32379-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/18/2016] [Accepted: 10/25/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND National Health Service Stop Smoking Services (SSSs) offer help to smokers motivated to quit; however, attendance rates are low and recent figures show a downward trend. We aimed to assess the effectiveness of a two-component personalised intervention on attendance at SSSs. METHODS We did this randomised controlled trial in 18 SSSs in England. Current smokers (aged ≥16 years) were identified from medical records in 99 general practices and invited to participate by their general practitioner. Individuals who gave consent, were motivated to quit, and had not attended the SSS within the past 12 months, were randomly assigned (3:2), via computer-generated randomisation with permuted blocks (block size of five), to receive either an individually tailored risk letter and invitation to attend a no-commitment introductory session run by the local SSS (intervention group) or a standard generic letter advertising the local SSS (control group). Randomisation was stratified by sex. Masking of participants to receipt of a personal letter and invitation to a taster session was not possible. The personal letter was generated by a research assistant, but the remainder of the research team were masked to group allocation. General practitioners, practice staff, and SSS advisers were unaware of their patients' allocation. The primary outcome was attendance at the first session of an SSS course within 6 months from randomisation. We did analysis by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN 76561916. FINDINGS Recruitment, collection of baseline data, delivery of the intervention, and follow up of participants took place between Jan 31, 2011, and July 12, 2014. We randomly assigned 4384 smokers to the intervention group (n=2636) or the control group (n=1748); 4383 participants comprised the intention-to-treat population. Attendance at the first session of an SSS course was significantly higher in the intervention group than in the control group (458 [17·4%] vs 158 [9·0%] participants; unadjusted odds ratio 2·12 [95% CI 1·75-2·57]; p<0·0001). INTERPRETATION Delivery of personalised risk information alongside an invitation to an introductory session more than doubled the odds of attending the SSS compared with a standard generic invitation to contact the service. This result suggests that a more proactive approach, combined with an opportunity to experience local services, can reduce patient barriers to receiving treatment and has high potential to increase uptake. FUNDING National Institutes of Health Research Health Technology Assessment.
Collapse
Affiliation(s)
- Hazel Gilbert
- Research Department of Primary Care and Population Health, UCL, London, UK.
| | - Stephen Sutton
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Richard Morris
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - Simon Galton
- Smokefree Camden (Public Health), NHS Camden, London, UK
| | - Qi Wu
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Irwin Nazareth
- Research Department of Primary Care and Population Health, UCL, London, UK
| |
Collapse
|
29
|
Abstract
BACKGROUND Exposure to nicotine via tobacco smoking may influence leptin release and decrease food intake among smokers. However, the effect of nicotine exposure on leptin and food intake among different nicotine dependent groups is unclear. OBJECTIVE We aimed to measure leptin and calorie intake among different nicotine dependent groups. DESIGN Cross-sectional study. SETTING Research department in school of medical sciences. PATIENTS AND METHODS Subjects were selected by purposive (non-probability) sampling and categorized as having low, moderate and high nicotine dependency based on the Fagerstrom Test for Nicotine Dependence (FTND) score. Diet was recorded by interview. Anthropometry, blood pressure, body composition, lipid profile, and physical activity level were measured accordingly. Fasting serum leptin was measured using a commercial ELISA kit. MAIN OUTCOME MEASURE(S) Nicotine dependency, 24-hour diet, clinical anthropometric and clinical measurements. RESULTS In 107 Malay male smokers leptin concentration was inversely correlated with nicotine dependence. However, body weight, smoking period, blood pressure, body composition, lipid profile and physical activity level were not significantly different among low, moderately and highly dependent smoking groups. Leptin concentration and total calorie intake were also not significantly different among these groups. CONCLUSION Leptin concentration was inversely correlated with nicotine dependence, but leptin concentration and total calorie intake status were not significantly different among our different nicotine dependency subjects. LIMITATIONS Purposive sampling for subject recruitment and inaccurate information in the self-administered questionnaire.
Collapse
Affiliation(s)
| | | | | | - Harmy Mohamed Yusoff
- Prof. Dr. Harmy Mohamed Yusoff, Faculty of Medicine and Health Sciences,, Universiti Sultan Zainal Abidin, City Campus,, 20400 Kuala Terengganu, Terengganu, Malaysia, T: +609 627 5771, F: +609 667 5583, , ORCID: http://orcid. org/0000-0001-6918-1549
| |
Collapse
|
30
|
Grill K, Voigt K. The case for banning cigarettes. JOURNAL OF MEDICAL ETHICS 2016; 42:293-301. [PMID: 26578712 DOI: 10.1136/medethics-2015-102682] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/22/2015] [Indexed: 06/05/2023]
Abstract
Lifelong smokers lose on average a decade of life vis-à-vis non-smokers. Globally, tobacco causes about 5-6 million deaths annually. One billion tobacco-related deaths are predicted for the 21st century, with about half occurring before the age of 70. In this paper, we consider a complete ban on the sale of cigarettes and find that such a ban, if effective, would be justified. As with many policy decisions, the argument for such a ban requires a weighing of the pros and cons and how they impact on different individuals, both current and future. The weightiest factor supporting a ban, we argue, is the often substantial well-being losses many individuals suffer because of smoking. These harms, moreover, disproportionally affect the disadvantaged. The potential gains in well-being and equality, we argue, outweigh the limits a ban places on individuals' freedom, its failure to respect some individuals' autonomous choice and the likelihood that it may, in individual cases, reduce well-being.
Collapse
Affiliation(s)
- Kalle Grill
- Department of Historical, Philosophical and Religious Studies, University of Umeå, Umea, Sweden
| | - Kristin Voigt
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, UK Institute for Health and Social Policy & Department of Philosophy, McGill University, Canada
| |
Collapse
|
31
|
Abstract
The tobacco epidemic is increasingly concentrated in low- and middle-income countries (LMICs) (WHO, 2008). These countries often have very limited resources and infrastructure to confront this epidemic. Public knowledge of tobacco health harms may be quite limited and, unfortunately, this is often true for health professionals as well (Nichter, 2006). Clinical practice guidelines have identified effective tobacco cessation interventions (Clinical Practice Guideline, 2008), but these have been focused primarily upon high-income countries. Approaches that have been successful in high-income countries may not be directly applicable in low-resource settings. Thus, for example, medications may not be readily accessible and infrastructure to support quit line programs may be minimal or non-existent.
Collapse
|
32
|
Tobacco use and associated factors among adults in Ethiopia: further analysis of the 2011 Ethiopian Demographic and Health Survey. BMC Public Health 2015; 15:487. [PMID: 25966998 PMCID: PMC4455703 DOI: 10.1186/s12889-015-1820-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/05/2015] [Indexed: 11/26/2022] Open
Abstract
Background Tobacco is one of the leading preventable causes of non-communicable diseases. Previous studies gave due emphasis only for cigarette smoking with little attention given for other types of tobacco use. This study describes the prevalence of all common forms of tobacco use and identify associated factors among adults in Ethiopia. Methods The study used data from the 2011 Ethiopian demographic and health survey. An index was constructed from yes or no responses for common types of tobacco use. Bivariate and multivariate logistic regression statistical models were employed to determine associated factors with tobacco using adjusted odds ratios (AOR) and their 95 % confidence intervals (CI). Results The overall prevalence of tobacco use was 4.1 % [95 % CI: (3.93–4.37)]. The highest prevalence 16.9 % [95 % CI: (11.02–23.76)] in Gambella and the lowest 0.8 % [95 % CI: (0.48–1.29)] in Tigray regions were reported. The odds of tobacco use in the age group 20–24 and 45–49 years were [AOR = 2.3; 95 % CI: (1.60–3.21)] and [AOR = 9.1; 95 % CI: (6.06–13.54)] more likely to use tobacco, respectively, as compared to the age group 15–19 years. Traditional religion [AOR = 5.5; 95 % CI: (3.96–7.55)], Catholics [AOR = 3.40; 95 % CI: (2.03–5.69)] and Islamic followers [AOR = 2.8; 95 % CI: (2.31–3.32)] had higher odds of using tobacco as compared to Orthodox religion followers. Adults in the poorest wealth quintile were [AOR = 1.4; 95 % CI: (1.05–1.79)] more likely to use tobacco as compared to the richest wealth quintile. The odds of tobacco use among males were higher as compared to females [AOR = 13.08; 95 % CI: (10.24–16.72)]. Formerly married adults were [AOR = 1.71; 95 % CI: (1.20–2.34)] more likely to use tobacco as compared to never married. Adults who were professionally working [AOR = 0.49; 95 % CI: (0.29–0.85)] had less likely to use tobacco as compared to non-working adults. However, adults who were working in sales, skilled and unskilled occupations had [AOR = 1.6; 95 % CI: (1.18–2.24)], [AOR = 1.7, 95 % CI: (1.21–2.50)] and [AOR = 3.8 95 % CI: (2.27–6.23)] more likely to use tobacco, respectively, as compared to non-working adults. Individuals who had experience of child death were [AOR = 1.4; 95 % CI: (1.17–1.63)] more likely to use tobacco as compared to their counterparts. Conclusion The overall prevalence of tobacco use seems low in Ethiopia. However, a significant regional variation of tobacco use was observed. A tailored public health interventions targeting regions with high prevalence of tobacco use is recommended.
Collapse
|
33
|
Jha P. The 21st century benefits of smoking cessation in Europe. Eur J Epidemiol 2013; 28:617-9. [DOI: 10.1007/s10654-013-9835-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
|
34
|
Editorial: Addressing Cardiovascular Disease Globally for Near-Term Impact: Yes We Can. Public Health Rev 2011. [DOI: 10.1007/bf03391639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|