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Cassidy RN, Bello MS, Denlinger-Apte R, Goodwin C, Godin J, Strahley AE, Wiseman KD, Hatsukami D, Donny E, Tidey JW, Colby SM. The impact of the COVID-19 pandemic on a sample of US young adults who smoke cigarettes: A qualitative analysis. Addict Behav 2023; 141:107650. [PMID: 36791643 PMCID: PMC9901227 DOI: 10.1016/j.addbeh.2023.107650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The ongoing COVID-19 pandemic has been associated with increased negative mood in youth, and a few reports of changes in tobacco use. We sought to increase the depth of knowledge on the effects of the pandemic on early young adult mood states, access to tobacco products and tobacco use behaviors, and knowledge of risks associated with tobacco use and COVID-19 by learning more about the lived experience of the pandemic among young adults early in their smoking trajectories. METHODS Semi-structured qualitative interviews were conducted with 25 young adults ages 18-20 (M = 19) who smoked cigarettes daily or nearly every day and had used electronic cigarettes (ECs) on ≥ 2 occasions in their lifetime. RESULTS Our results uncovered several themes: 1) The majority of teens experienced mental health disturbances as a result of the pandemic, which manifested as depression, anxiety, and/or acute loneliness due to social isolation; 2) tobacco purchasing behaviors sometimes changed, with both greater and less access reported among participants; 3) changes in tobacco use were also reported, with some reporting increases in use, others reporting decreases, and a few reporting quitting; and 4) while some youth reported that tobacco use could increase their risk related to COVID-19, the majority reported confusion and uncertainty about how tobacco use impacted their risk. CONCLUSIONS The themes identified specific factors that may account for the heterogeneity of impacts of the pandemic on tobacco use, and highlight the value of qualitative work for centering the lived experience of youth for understanding larger trends in substance use.
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Affiliation(s)
- Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University, United States.
| | - Mariel S Bello
- Center for Alcohol and Addiction Studies, Brown University, United States
| | - Rachel Denlinger-Apte
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, United States
| | - Christine Goodwin
- Center for Alcohol and Addiction Studies, Brown University, United States
| | - Julissa Godin
- Center for Alcohol and Addiction Studies, Brown University, United States
| | - Ashley E Strahley
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, United States
| | - Kimberly D Wiseman
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, United States
| | | | - Eric Donny
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, United States
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, United States
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University, United States
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Nahum-Shani I, Potter LN, Lam CY, Yap J, Moreno A, Stoffel R, Wu Z, Wan N, Dempsey W, Kumar S, Ertin E, Murphy SA, Rehg JM, Wetter DW. The mobile assistance for regulating smoking (MARS) micro-randomized trial design protocol. Contemp Clin Trials 2021; 110:106513. [PMID: 34314855 PMCID: PMC8824313 DOI: 10.1016/j.cct.2021.106513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Abstract
Smoking is the leading preventable cause of death and disability in the U.S. Empirical evidence suggests that engaging in evidence-based self-regulatory strategies (e.g., behavioral substitution, mindful attention) can improve smokers' ability to resist craving and build self-regulatory skills. However, poor engagement represents a major barrier to maximizing the impact of self-regulatory strategies. This paper describes the protocol for Mobile Assistance for Regulating Smoking (MARS) - a research study designed to inform the development of a mobile health (mHealth) intervention for promoting real-time, real-world engagement in evidence-based self-regulatory strategies. The study will employ a 10-day Micro-Randomized Trial (MRT) enrolling 112 smokers attempting to quit. Utilizing a mobile smoking cessation app, the MRT will randomize each individual multiple times per day to either: (a) no intervention prompt; (b) a prompt recommending brief (low effort) cognitive and/or behavioral self-regulatory strategies; or (c) a prompt recommending more effortful cognitive or mindfulness-based strategies. Prompts will be delivered via push notifications from the MARS mobile app. The goal is to investigate whether, what type of, and under what conditions prompting the individual to engage in self-regulatory strategies increases engagement. The results will build the empirical foundation necessary to develop a mHealth intervention that effectively utilizes intensive longitudinal self-report and sensor-based assessments of emotions, context and other factors to engage an individual in the type of self-regulatory activity that would be most beneficial given their real-time, real-world circumstances. This type of mHealth intervention holds enormous potential to expand the reach and impact of smoking cessation treatments.
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Affiliation(s)
- Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States of America.
| | - Lindsey N Potter
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America
| | - Cho Y Lam
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America
| | - Jamie Yap
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States of America
| | - Alexander Moreno
- College of Computing, Georgia Institute of Technology, Atlanta, GA, United States of America
| | - Rebecca Stoffel
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America
| | - Zhenke Wu
- School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Neng Wan
- Department of Geography, University of Utah, Salt Lake City, UT, United States of America
| | - Walter Dempsey
- School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Santosh Kumar
- Department of Computer Science, University of Memphis, Memphis, TN, United States of America
| | - Emre Ertin
- Department of Electrical and Computer Engineering, The Ohio State University, Columbus, OH, United States of America
| | - Susan A Murphy
- Departments of Statistics & Computer Science, Harvard University, Cambridge, MA, United States of America
| | - James M Rehg
- College of Computing, Georgia Institute of Technology, Atlanta, GA, United States of America
| | - David W Wetter
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America
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Camenga DR, Haeny AM, Krishnan-Sarin S, O’Malley SS, Bold KW. Pilot Ecological Momentary Assessment Study of Subjective and Contextual Factors Surrounding E-Cigarette and Combustible Tobacco Product Use among Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11005. [PMID: 34769525 PMCID: PMC8582640 DOI: 10.3390/ijerph182111005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dual use of e-cigarettes and combustible tobacco products is common in young adults. We aimed to explore how ratings of subjective and contextual factors differed between discrete episodes of e-cigarette use vs. combustible tobacco product smoking among a sample of young adults. METHODS Young adults (N = 29, ages 18-30) who used e-cigarettes and ≥1 combustible tobacco product at least once weekly completed a 1-week smartphone-based ecological momentary assessment (EMA). Twice daily random prompts assessed past-15-min use of tobacco products, ratings of subjective factors (e.g., negative affect, craving), and contextual factors related to activity, location, and companionship. A multivariable GEE model assessed whether subjective or contextual factors were associated with e-cigarette vs. combustible tobacco product episodes. RESULTS 184 tobacco use episodes were reported (39.7% e-cigarette, 60.3% combustible tobacco product). High baseline cigarette dependence, as measured by the Fagerström Test for Cigarette Dependence, was associated with lower odds of e-cigarette vs. combustible tobacco product episodes (aOR 0.01, 95% CI (0.002-0.08); p < 0.001). Neither between- or within-subjects negative affect or craving scores were associated with e-cigarette use. Activities of eating/drinking (aOR 0.20, 95% CI (0.08-0.49); p = 0.001) and being in the companionship of a person who smoked cigarettes (aOR 0.13, 95% CI (0.04-0.43); p = 0.001) were associated with lower odds of e-cigarette vs. combustible tobacco product use episodes. However, traveling (aOR 12.02, 95% CI (3.77-38.26); p ≤ 0.001) and being in a public space (aOR 2.76, 95% CI (1.10-6.96); p = 0.03) were associated with higher odds of e-cigarette than combustible tobacco product use episodes. CONCLUSIONS This pilot data suggests that unique contextual factors may be associated with e-cigarette use, compared to combustible tobacco smoking in a sample of young adults who use both e-cigarettes and combustible tobacco products. Future research with larger samples is needed to better characterize varying contexts and cues for tobacco use among young adults who are dual users.
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Affiliation(s)
- Deepa R. Camenga
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT 06519, USA
| | - Angela M. Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA; (A.M.H.); (S.K.-S.); (S.S.O.); (K.W.B.)
| | - Suchitra Krishnan-Sarin
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA; (A.M.H.); (S.K.-S.); (S.S.O.); (K.W.B.)
| | - Stephanie S. O’Malley
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA; (A.M.H.); (S.K.-S.); (S.S.O.); (K.W.B.)
| | - Krysten W. Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA; (A.M.H.); (S.K.-S.); (S.S.O.); (K.W.B.)
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Kang MJ, Lee H, Jo M. Analysis of multidimensional factors in attempts to quit using tobacco by Korean adolescents. Environ Health Prev Med 2020; 25:71. [PMID: 33218297 PMCID: PMC7679987 DOI: 10.1186/s12199-020-00913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background This study aims to understand the extent of adolescents’ attempts to quit using tobacco and the factors influencing such attempts in Korea, using a descriptive, cross-sectional design and secondary data analysis with the 2019 Youth Health Behavior Survey. Methods The participants were 4028 adolescent tobacco users who had used tobacco for 1 day or more in the past 30 days. The data analysis was performed using IBM SPSS/WIN 26.0 program, and multivariable logistic regression analysis was conducted using the complex sampling method module. Results A total of 68.2% of the participants attempted to quit using tobacco. We analyzed the factors for adolescents’ attempts to quit using tobacco by dividing them into psychological, physical, behavioral, and environmental dimensions. The factors influencing adolescents’ attempts to quit using tobacco, identified through multivariable logistic regression analysis, are as follows: participation in sports activities (OR = 1.20, 95% CI 1.01–1.41), vigorous physical activity (OR = 1.24, 95% CI 1.06–1.46), and type of tobacco product used (OR = 1.65, 95% CI 1.24–2.21) in the behavioral dimension; pictorial cigarette pack warnings (perceived smoking as unhealthy) (OR = 1.91, 95% CI 1.56–2.36), and the presence of secondhand smoking at home (OR = 1.18, 95% CI 1.01–1.38) in the environmental dimension. Conclusions Schools and public healthcare providers must consider multidimensional factors when providing support for successful tobacco cessation in adolescents and focus particularly on elements relating to physical activity and environmental factors.
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Affiliation(s)
- Mi-Jung Kang
- College of Nursing, Department of Nursing, Eulji University, Daejeon, 34824, Republic of Korea
| | - Hyunjin Lee
- College of Nursing, Department of Nursing, Eulji University, Daejeon, 34824, Republic of Korea.
| | - Mirae Jo
- College of Nursing, Department of Nursing, Eulji University, Daejeon, 34824, Republic of Korea
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Treloar Padovano H, Merrill JE, Colby SM, Kahler CW, Gwaltney CJ. Affective and Situational Precipitants of Smoking Lapses Among Adolescents. Nicotine Tob Res 2020; 22:492-497. [PMID: 30624745 DOI: 10.1093/ntr/ntz002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/07/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Most adolescent smokers report a desire to quit, and many have made several unsuccessful quit attempts; however, when adolescents attempt to quit, they often resume smoking quickly. This ecological study aimed to (1) characterize affective and situational precipitants of smoking lapses among adolescents and (2) explore the moderating influence of nicotine dependence severity on lapse precipitants. METHODS Adolescent daily smokers (n = 166; ages 14-18 years) completed electronic diaries of cigarettes smoked, craving and affective states, and situational variables on handheld computers in their natural environment for 2 weeks following an unassisted quit attempt. On average, adolescents were moderately nicotine dependent (Modified Fagerström Tolerance Questionnaire [mFTQ] score = 4.9; SD = 1.6). RESULTS Craving was a significant episodic cue for lapse and stable influence on lapse, relating to 44% and 15% increased odds of lapse, respectively. High-arousal affective states-regardless of valence-were associated with 12%-13% increased odds of lapse. Low-arousal positive affective states were associated with 17% decreased odds of lapse. A 1-unit difference in a teen's mFTQ score related to 27% increased odds of lapse, but dependence severity did not moderate proximal lapse influences. CONCLUSIONS This report provides some of the first ecological data characterizing adolescent smoking lapses following a quit attempt. As in prior work with teens, lapses were nearly universal and quickly followed the quit attempt. Specific situational and affective contexts of smoking lapses for adolescents were implicated, indicating the need for cessation interventions to address craving and high-arousal affective states as precipitators of lapse in this high-risk group. IMPLICATIONS This report provides some of the first ecological data characterizing smoking lapses among teens attempting to quit smoking on their own. Like adults, adolescents face many barriers when making quit attempts. The present work provides ecological data to suggest that the experience of heightened arousal in teens' daily lives interferes with their efforts to quit smoking. Thus, this work highlights the importance of affective dysregulation, or amplitude of emotional feelings, for teen smoking lapses. Moment-to-moment fluctuation in craving was also implicated as a dynamic precipitator of smoking lapse in this high-risk group.
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Affiliation(s)
- Hayley Treloar Padovano
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI.,Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Jennifer E Merrill
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI.,Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Chad J Gwaltney
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
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Dvorak RD, Waters AJ, MacIntyre JM, Gwaltney CJ. Affect, craving, and cognition: An EMA study of ad libitum adolescent smoking. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:583-594. [PMID: 30211581 PMCID: PMC6137814 DOI: 10.1037/adb0000392] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Reducing smoking among adolescents is a public health priority. Affect, craving, and cognitive processes have been identified as predictors of smoking in adolescents. The current study examined associations between implicit attitude for smoking (assessed via the positive-negative valence implicit association test) and affect, craving, and smoking assessed using ecological momentary assessment (EMA). Adolescent smokers (n = 154; Mage = 16.57, SD = 1.12) completed a laboratory assessment of implicit smoking attitudes and carried a palm-top computer for several days while smoking ad libitum. During EMA, they recorded affect, craving, and smoking behavior. Data were analyzed using a multilevel path analysis. At the between-subjects level, more positive implicit smoking attitude was indirectly associated with smoking rate via craving. This association was moderated by positive affect, such that it was stronger for those with greater traitlike positive affect. At the event (within-subject) level, implicit attitude potentiated associations between stress and craving and between positive affect and craving. Individuals with a more positive implicit attitude exhibited more robust indirect associations between momentary stress-positive affect and smoking. In sum, a more positive implicit attitude to smoking was associated with overall levels of craving and smoking and might have potentiated momentary affect-craving associations. Interventions that modify implicit attitude may be an approach for reducing adolescent smoking. (PsycINFO Database Record
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McClure EA, Tomko RL, Carpenter MJ, Treiber FA, Gray KM. Acceptability and compliance with a remote monitoring system to track smoking and abstinence among young smokers. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 44:561-570. [PMID: 29737885 PMCID: PMC6059983 DOI: 10.1080/00952990.2018.1467431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/11/2017] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Similar to adult smokers, quit attempts among younger smokers almost inevitably result in relapse. Unlike adults, less is known about the process of relapse in this younger age group. A technology-based remote monitoring system may allow for detailed and accurate characterization of smoking and abstinence and would help to improve cessation strategies. OBJECTIVES This study describes a mobile system that captures smoking using breath carbon monoxide (CO) and real-time self-reports of smoking behavior. Compliance, feasibility, acceptability, and accuracy of the system were measured during a quit attempt and subsequent monitoring period. METHODS The mobile application (My Mobile Monitor, M3) combined breath CO with ecological momentary assessment, delivered via smartphone. Participants (N = 16; 75% female) were daily smokers between the ages of 19 and 25, who used the app for 11 days during which they agreed to make a quit attempt. Acceptability, compliance, and abstinence were measured. RESULTS Participants averaged 22.3 ± 2.0 years old and smoked an average of 13.0 ± 6.1 cigarettes per day. Overall session compliance was 69% and during the quit attempt, 56% of participants abstained from smoking for at least 24 hours. Agreement between self-reported smoking compared to breath CO was generally high, when available for comparison, though underreporting of cigarettes was likely. CONCLUSION This study demonstrates feasibility of a remote monitoring app with younger smokers, though improvements to promote compliance are needed. Remote monitoring to detect smoking and abstinence represents a step forward in the improvement of cessation strategies, but user experience and personalization are vital.
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Affiliation(s)
- Erin A. McClure
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel L. Tomko
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew J. Carpenter
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Frank A. Treiber
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Fanshawe TR, Halliwell W, Lindson N, Aveyard P, Livingstone‐Banks J, Hartmann‐Boyce J. Tobacco cessation interventions for young people. Cochrane Database Syst Rev 2017; 11:CD003289. [PMID: 29148565 PMCID: PMC6486118 DOI: 10.1002/14651858.cd003289.pub6] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006. OBJECTIVES To evaluate the effectiveness of strategies that help young people to stop smoking tobacco. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register in June 2017. This includes reports for trials identified in CENTRAL, MEDLINE, Embase and PsyclNFO. SELECTION CRITERIA We included individually and cluster-randomized controlled trials recruiting young people, aged under 20 years, who were regular tobacco smokers. We included any interventions for smoking cessation; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months' follow-up among those who smoked at baseline. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of candidate trials and extracted data. We evaluated included studies for risk of bias using standard Cochrane methodology and grouped them by intervention type and by the theoretical basis of the intervention. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at six months' follow-up. MAIN RESULTS Forty-one trials involving more than 13,000 young people met our inclusion criteria (26 individually randomized controlled trials and 15 cluster-randomized trials). We judged the majority of studies to be at high or unclear risk of bias in at least one domain. Interventions were varied, with the majority adopting forms of individual or group counselling, with or without additional self-help materials to form complex interventions. Eight studies used primarily computer or messaging interventions, and four small studies used pharmacological interventions (nicotine patch or gum, or bupropion). There was evidence of an intervention effect for group counselling (9 studies, risk ratio (RR) 1.35, 95% confidence interval (CI) 1.03 to 1.77), but not for individual counselling (7 studies, RR 1.07, 95% CI 0.83 to 1.39), mixed delivery methods (8 studies, RR 1.26, 95% CI 0.95 to 1.66) or the computer or messaging interventions (pooled RRs between 0.79 and 1.18, 9 studies in total). There was no clear evidence for the effectiveness of pharmacological interventions, although confidence intervals were wide (nicotine replacement therapy 3 studies, RR 1.11, 95% CI 0.48 to 2.58; bupropion 1 study RR 1.49, 95% CI 0.55 to 4.02). No subgroup precluded the possibility of a clinically important effect. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. Our certainty in the findings for all comparisons is low or very low, mainly because of the clinical heterogeneity of the interventions, imprecision in the effect size estimates, and issues with risk of bias. AUTHORS' CONCLUSIONS There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.
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Affiliation(s)
- Thomas R Fanshawe
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
| | - William Halliwell
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
| | - Nicola Lindson
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
| | - Paul Aveyard
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
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Bongard S, Olson L, Nakajima M, al'Absi M. Anger Expression Style Predicts the Domain of the First Smoking Relapse After a Quit Attempt. Subst Use Misuse 2016; 51:1810-4. [PMID: 27556871 PMCID: PMC5034761 DOI: 10.1080/10826084.2016.1197259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Risk for smoking relapse may be associated with context-dependent social and behavioral cues. However, lack of research examining the role of trait negative mood such as anger in this relationship and assessment of objective indices related to smoking status (e.g., biochemical measures) may limit existing findings. We examined the roles of trait anger, habitual anger expression behavior, and the situation in which the first incident of smoking lapse following a quit attempt occurs. METHODS One-hundred and five smokers interested in cessation (mean age, SD: 34.7 ± 11.8) set a quit day and attended multiple post-quit assessments where they were asked to provide biochemical measures including exhaled carbon monoxide (CO) and self-report measurements, including smoking status. RESULTS Eighty-eight participants (40 women) returned to smoking over the 12-month study period. Self-reported smoking status was verified by exhaled CO measurements. Thirty-one percent of participants who relapsed reported the first lapse occurring at home, 15% at work, 14% at a restaurant or a bar, and 8% in a car. Multinomial logistic regression models found that high levels of anger-out were associated with smoking relapse in situations other than work or home (p <.05). CONCLUSIONS These results expand prior work suggesting habitual anger expression style may moderate associations between situational factors and risk for smoking relapse, highlighting the need to incorporate findings in treatment methods. Absence of gender differences suggests the situational factors explored here affect relapse independent of gender.
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Affiliation(s)
- Stephan Bongard
- a Department of Psychology , Goethe-University , Frankfurt am Main , Germany
| | - Leif Olson
- b University of Minnesota Medical School , Duluth , Minnesota , USA
| | | | - Mustafa al'Absi
- b University of Minnesota Medical School , Duluth , Minnesota , USA
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Abstract
INTRODUCTION The age of starting the habit of smoking, one of the top causes of many illnesses, is usually in the period of adolescence. This study was conducted to determine students' smoking status and to explore their desire to quit and their experiences during the cessation process. METHODS This descriptive study was performed with 934 adolescents between the ages of 14 and 20 years at a vocational high school located in Istanbul, Turkey. The data were collected by using a survey form. RESULTS The mean age of the adolescents was 16.38 ± 1.12 years. Among the adolescents, 90.3% were male. Of the group, 29.9% reported that they had smoked at least once, and 12.1% of the participants smoked regularly. Among the students who smoked, 80% reported that they wanted to quit smoking. Among the smokers, 55.2% reported that they tried to quit smoking but could only stop smoking for a period of between 1 day and 1 month at maximum (71.4%). A group of 68.9% reported that they wanted to quit because they were afraid of getting sick in the future, 28.8% indicated economic reasons to quit smoking, and 24.2% reported that they wanted to stop smoking because they did not want to damage the environment. CONCLUSION More than half of the smokers among the students had tried to stop smoking, but most of them had failed to quit. These results indicate that schools need programs for the cessation and the prevention of smoking.
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Roberts ME, Bidwell LC, Colby SM, Gwaltney CJ. With others or alone? Adolescent individual differences in the context of smoking lapses. Health Psychol 2015; 34:1066-75. [PMID: 25664557 DOI: 10.1037/hea0000211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Although a great deal of adolescent smoking research has investigated predictors of initiation, much less has focused on predictors of lapsing during a quit attempt. In particular, the role of social context may deserve greater attention in models of adolescent smoking cessation. Therefore, the present investigation aimed to use ecological momentary assessment (EMA) to examine individual differences in social lapsing--the extent to which lapses occur around others versus when alone. METHODS Analyses focused on 179 adolescent smokers (aged 14-18 years) engaged in an unassisted quit attempt. There were 2 general EMA assessment intervals: prequit (1 week) and postquit (2 weeks). Participants reported every time that they smoked a cigarette and at random, nonsmoking times; in each assessment, participants responded to questions about their current environment, behaviors, and psychological state. A 3-month follow-up assessed longer-term smoking-related outcomes. RESULTS Consistent with other adolescent research, the overall rate of lapsing was very high (93%). Social lapsing rates were likewise high (among those who lapsed, 73% reported their first lapse was social), but they also varied continuously across individuals. We computed a social lapsing coefficient for each youth and found that it related to smoking factors at baseline (e.g., lower smoking intensity and dependence) and follow-up (e.g., lower cotinine levels). CONCLUSIONS These results suggest that higher rates of social lapsing are associated with being a lighter, less dependent smoker and having better eventual cessation prospects. Findings provide evidence that accounting for variability in social lapsing may improve theory and treatment.
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Vardavas CI, Agaku I, Patelarou E, Anagnostopoulos N, Nakou C, Dramba V, Giourgouli G, Argyropoulou P, Antoniadis A, Gourgoulianis K, Ourda D, Lazuras L, Bertic M, Lionis C, Connolly G, Behrakis P. Ashtrays and signage as determinants of a smoke-free legislation's success. PLoS One 2013; 8:e72945. [PMID: 24023795 PMCID: PMC3762932 DOI: 10.1371/journal.pone.0072945] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/21/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction Successful smoke-free legislation is dependent on political will, enforcement and societal support. We report the success and pitfalls of a non-enforced nationwide smoke-free legislation in Greece, as well as ways in which compliance and enforcement-related factors, including ashtrays and signage, may impact indoor secondhand smoke (SHS) concentrations. Methods A follow-up study of venues (n = 150, at baseline, n = 75 at 2-year follow-up) in Greece assessed indoor particulate matter with a diameter less than 2.5 micrometers (PM2.5) concentrations attributable to SHS smoke every six months for two years (n = 455 venue/measurements). Results Following the implementation of the 2010 smoke-free legislation, mean PM2.5 concentrations attributable to SHS fell from 175.3 µg/m3 pre-ban to 84.52 µg/m3 immediately post-ban, increasing over subsequent waves (103.8 µg/m3 and 158.2 µg/m3 respectively). Controlling for potential influential factors such as ventilation, time of day, day of week, city and venue type, all post-ban measurements were still lower than during the pre-ban period (Wave 2 beta: −118.7, Wave 3 beta: −87.6, and Wave 4 beta: −69.9). Outdoor or indoor signage banning smoking was not found to affect SHS concentrations (beta: −10.9, p = 0.667 and beta: −18.1, p = 0.464 respectively). However, ashtray or ashtray equivalents were strong determinants of the existence of indoor SHS (beta: +67 µg/m3, p = 0.017). Conclusions While the public may be supportive of smoke-free legislation, adherence may decline rapidly if enforcement is limited or nonexistent. Moreover, enforcement agencies should also focus on the comprehensive removal of ashtray equivalents that could act as cues for smoking within a venue.
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Affiliation(s)
- Constantine I. Vardavas
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Smoking and Lung Cancer Research Center, Hellenic Cancer Society, Athens, Greece
- Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece
- * E-mail:
| | - Israel Agaku
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Evridiki Patelarou
- Smoking and Lung Cancer Research Center, Hellenic Cancer Society, Athens, Greece
- Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece
| | | | - Chrysanthi Nakou
- Department of Medicine, Aristotelio University of Thessaloniki, Thessaloniki, Greece
| | - Vassiliki Dramba
- Department of Pulmonary Medicine, General Hospital of Serres, Serres, Greece
| | - Gianna Giourgouli
- Smoking and Lung Cancer Research Center, Hellenic Cancer Society, Athens, Greece
| | | | - Antonis Antoniadis
- Department of Pulmonary Medicine, General Hospital of Serres, Serres, Greece
| | | | - Despoina Ourda
- South Eastern European Research Center, Thessaloniki, Greece
| | - Lambros Lazuras
- South Eastern European Research Center, Thessaloniki, Greece
| | - Monique Bertic
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Christos Lionis
- Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece
| | - Gregory Connolly
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Panagiotis Behrakis
- Smoking and Lung Cancer Research Center, Hellenic Cancer Society, Athens, Greece
- Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
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Abstract
BACKGROUND Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the second update of a Cochrane review first published in 2006. OBJECTIVES To evaluate the effectiveness of strategies that help young people to stop smoking tobacco. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register in February 2013. This includes reports for trials identified in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsyclNFO. SELECTION CRITERIA We included randomized controlled trials, cluster-randomized controlled trials and other controlled trials recruiting young people, aged less than 20, who were regular tobacco smokers. We included any interventions; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months follow-up among those who smoked at baseline. DATA COLLECTION AND ANALYSIS Both authors independently assessed the eligibility of candidate trials and extracted data. Included studies were evaluated for risk of bias using standard Cochrane methodology. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at longest follow-up. MAIN RESULTS Twenty-eight trials involving approximately 6000 young people met our inclusion criteria (12 cluster-randomized controlled trials, 14 randomized controlled trials and 2 controlled trials). The majority of studies were judged to be at high or unclear risk of bias in at least one domain. Many studies combined components from various theoretical backgrounds to form complex interventions.The majority used some form of motivational enhancement combined with psychological support such as cognitive behavioural therapy (CBT) and some were tailored to stage of change using the transtheoretical model (TTM). Three trials based mainly on TTM interventions achieved moderate long-term success, with a pooled risk ratio (RR) of 1.56 at one year (95% confidence interval (CI) 1.21 to 2.01). The 12 trials that included some form of motivational enhancement gave an estimated RR of 1.60 (95% CI 1.28 to 2.01). None of the 13 individual trials of complex interventions that included cognitive behavioural therapy achieved statistically significant results, and results were not pooled due to clinical heterogeneity. There was a marginally significant effect of pooling six studies of the Not on Tobacco programme (RR of 1.31, 95% CI 1.01 to 1.71), although three of the trials used abstinence for as little as 24 hours at six months as the cessation outcome. A small trial testing nicotine replacement therapy did not detect a statistically significant effect. Two trials of bupropion, one testing two doses and one testing it as an adjunct to NRT, did not detect significant effects. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. AUTHORS' CONCLUSIONS Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence or continuous abstinence at six months), especially those incorporating elements sensitive to stage of change and using motivational enhancement and CBT. Given the episodic nature of adolescent smoking, more data is needed on sustained quitting. There were few trials with evidence about pharmacological interventions (nicotine replacement and bupropion), and none demonstrated effectiveness for adolescent smokers. There is not yet sufficient evidence to recommend widespread implementation of any one model. There continues to be a need for well-designed adequately powered randomized controlled trials of interventions for this population of smokers.
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Affiliation(s)
- Alan Stanton
- Heart of England Foundation Trust, 3, The Green, Shirley, UK, B90 4LA
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