1
|
Chen H, Yip AON, Cheung YTD, Chan SSC, Lam TH, Wang MP, Luk TT. Reaching Youth Smokers Through a Multipronged Approach: Comparison of Three Recruitment Methods of a Youth Quitline in Hong Kong. J Adolesc Health 2024:S1054-139X(24)00377-X. [PMID: 39340497 DOI: 10.1016/j.jadohealth.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 06/04/2024] [Accepted: 07/17/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE Using multipronged recruitment strategies is crucial for reaching diverse smokers, yet research specifically focusing on youths is lacking. This prospective study compared the characteristics and abstinence outcomes of youth smokers enrolled in a youth-centered cessation service by three different methods. METHODS From December 2016 to February 2022, the Youth Quitline enrolled 1,197 smokers aged 10-25 (mean = 19.4) years through traditional method (incoming calls or referrals, n = 276), proactive outreach (n = 735), and online method (website or social media platforms, n = 186). Logistic regression was used to calculate the odds ratio (OR) of biochemically validated tobacco abstinence at 6 months by recruitment methods. RESULTS Proportionally more participants recruited via online method than traditional method and outreach had moderate to heavy nicotine dependence (53.2% vs. 40.9% vs. 27.6%, p < .001), poor self-rated health (27.6% vs. 21.9% vs. 12.3%, p < .001), and risk of depression (51.4% vs. 42.5% vs. 37.4%, p = .003). More participants recruited by outreach (71.6%) had no intention to quit in 30 days than traditional (58.3%) and online (59.7%) methods (p < .001). Compared with traditional method, the 6-month validated abstinence rate was similar in smokers recruited by online method (crude OR 0.77, 95% confidence interval 0.44-1.34) but significantly lower in those recruited by outreach (crude OR 0.44, 95% confidence interval 0.28-0.67). Results were similar after adjusting for sociodemographic and baseline predictors of abstinence. DISCUSSION Online recruitment can attract youth smokers with greater nicotine dependence and poorer health, whereas outreach can engage those with less motivation to quit. The lower quit rate in outreach-recruited participants indicated the need for more effective interventions.
Collapse
Affiliation(s)
- Hong Chen
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Annie On Ni Yip
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yee Tak Derek Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sophia Siu Chee Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Man Ping Wang
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Tzu Tsun Luk
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
2
|
Kumari L, Sood M, Gupta S. Effect of age of tobacco initiation and number of failed quit attempts on maintenance of tobacco abstinence. J Cancer Res Ther 2024; 20:333-339. [PMID: 38554343 DOI: 10.4103/jcrt.jcrt_1780_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/09/2022] [Indexed: 04/01/2024]
Abstract
BACKGROUND The decision to make a quit attempt is the first step toward the tobacco cessation process. It is well established in the literature that if someone does not take tobacco till the age of 21 years then his chances of remaining tobacco-free for life are higher than his counterparts who start tobacco at early developmental ages. METHODOLOGY AND TOOLS The present study was conducted among 400 university undergraduate students. A cross-sectional survey design was used, multi-stage sampling was done, and four colleges were selected via random sampling. The motivation to quit tobacco, tobacco craving, and maintenance of tobacco abstinence was assessed via contemplation ladder, tobacco craving questionnaire Short Form, and smoking abstinence questionnaire. To validate subjective data, a urine cotinine test was performed. RESULTS The age of tobacco initiation significantly impacts intentions to quit tobacco and tobacco craving levels. The number of unsuccessful quit attempts was also significantly associated with the maintenance of tobacco abstinence. The failed quit attempts play a vital role in altering tobacco cravings and make the withdrawals more complicated to handle for recent tobacco quitters.
Collapse
Affiliation(s)
- Laxmi Kumari
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Meenakshi Sood
- Chitkara School of Health Sciences, Chitkara University, Punjab, India
| | | |
Collapse
|
3
|
Ho KY, Lam KKW, Wu CST, Leung DYP, Yeung WF, Hung TM, Ting S, Tong MN, Tang LN, Mak YW. Utilization of the Youth Quitline as an opportunity for an undergraduate nursing students to deliver smoking cessation counseling as their clinical placement: An implementation of a service-learning model. NURSE EDUCATION TODAY 2022; 112:105330. [PMID: 35303543 DOI: 10.1016/j.nedt.2022.105330] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Smoking is an important modifiable risk factor of morbidities and mortality. Although healthcare professionals play an important role in smoking cessation, their adoption of such practices is relatively low because of inadequate training. To address this issue, we incorporated a service-learning model to operate the Youth Quitline. Undergraduate nursing students were trained and received supervision while delivering smoking cessation counseling through the Youth Quitline as their clinical placement. OBJECTIVES We evaluated the effectiveness of the placement by assessing students' knowledge, attitudes and practices regarding smoking cessation and tobacco control. DESIGN One-group pretest-posttest design. SETTING Youth Quitline. PARTICIPANTS A total of 61 third-year students in a mental health nursing program. METHODS Students were required to complete 80 h at the Youth Quitline. The 80 h were divided into 20 sessions; students used four sessions to approach and recruit youth smokers in the community, then provided them with telephone counseling for the rest of the time. Prior to the placement, students attended a 2-day workshop. The outcomes were changes in students' knowledge, attitudes and practices regarding smoking cessation and tobacco control 3 months after the placement compared with baseline. RESULTS From January-June 2021, students conducted 105 outreach activities to identify 3142 smokers in the community, and provided telephone counseling for 336 smokers via Youth Quitline. Compared with baseline, significant improvements were observed in students' knowledge, attitudes and practices regarding smoking cessation and tobacco control at 3-month follow-up. CONCLUSIONS The clinical placement improved students' knowledge, attitudes and practices regarding smoking cessation and tobacco control, enhancing their competency in providing support to assist smokers to quit in their future practice. Incorporating the service-learning model in existing community-based services can provide additional venues for nursing students to practice. This is particularly important because many venues have restricted access during the COVID-19 pandemic.
Collapse
Affiliation(s)
- K Y Ho
- School of Nursing, Hong Kong Polytechnic University, Hong Kong.
| | | | - C S T Wu
- School of Nursing, Hong Kong Polytechnic University, Hong Kong
| | - D Y P Leung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong
| | - W F Yeung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong
| | - T M Hung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong
| | - S Ting
- School of Nursing, Hong Kong Polytechnic University, Hong Kong
| | - M N Tong
- School of Nursing, Hong Kong Polytechnic University, Hong Kong
| | - L N Tang
- School of Nursing, Hong Kong Polytechnic University, Hong Kong
| | - Y W Mak
- School of Nursing, Hong Kong Polytechnic University, Hong Kong
| |
Collapse
|
4
|
Xia W, Li HCW, Liang T, Luo Y, Ho LLK, Cheung AT, Song P. Structured online training for university students to deliver peer-led addiction counselling for young drug abusers in China: Effect on improving knowledge, attitude, confidence, and skills. PATIENT EDUCATION AND COUNSELING 2022; 105:1009-1017. [PMID: 34334262 DOI: 10.1016/j.pec.2021.07.038] [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: 03/25/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To measure the effect of a structured online training programme on improving the knowledge, attitude, confidence, and skills of university students to deliver peer-led addiction counselling to young drug abusers. METHODS A structured training programme was designed for university students with a background in health-related disciplines. Pre- and post-training evaluations were conducted for 245 university students with health-related backgrounds who completed the training programme. The participants' knowledge of and attitudes towards drug abuse and their confidence in delivering addiction counselling were evaluated and compared before and after the training. Counselling skills were assessed using a simulated standardised case. RESULTS A paired test indicated that after attending the training programme, the participants' knowledge of and attitudes towards drug abuse and their confidence in delivering addiction counselling were significantly improved. Most of the trained participants demonstrated satisfactory counselling skills. CONCLUSION Participation in a one-day structured addiction training programme significantly improved students' knowledge of and attitudes towards drug abuse and their confidence and skills to deliver addiction counselling. PRACTICE IMPLICATION Future research should elucidate the implementation of the counselling skills in terms of the counselling outcomes and successful referral. The clients' health outcomes should be assessed to reflect the peer counsellors' skills.
Collapse
Affiliation(s)
- Wei Xia
- School of Nursing, Sun Yat-Sen University, Guangzhou, China; School of Nursing, The University of Hong Kong, Hong Kong SAR.
| | | | - Tingna Liang
- School of Nursing, The University of Hong Kong, Hong Kong SAR.
| | - Yuanhui Luo
- School of Nursing, The University of Hong Kong, Hong Kong SAR.
| | | | | | - Peige Song
- Zhejiang University School of Medicine, Hangzhou, China; Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
5
|
Xia W, Li WHC, Luo YH, Liang TN, Ho LLK, Cheung AT, Song P. The association between heated tobacco product use and cigarette cessation outcomes among youth smokers: A prospective cohort study. J Subst Abuse Treat 2021; 132:108599. [PMID: 34419325 DOI: 10.1016/j.jsat.2021.108599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The U.S. Food and Drug Administration authorized the marketing of heated tobacco products (HTPs) with modified-risk information for adults on July 7, 2020. However, the effects of HTP use on cigarette cessation among youth smokers remain unclear. This study aimed to explore the association of HTP use with cigarette abstinence and cessation outcomes among youth smokers in Hong Kong who were willing to receive telephone counseling for smoking cessation. METHODS This prospective cohort study included youth smokers aged ≤25 years who were enrolled in the Hong Kong Youth Quitline service. From December 1, 2016, to September 30, 2019, this study identified as HTP users 106 youth cigarette smokers who reported using HTPs on at least 1 of the past 30 days at enrollment, and identified as non-HTP users 473 smokers who reported smoking at least one conventional cigarette in the past 30 days and never using HTPs. The participants received follow-ups at 1 week and 1-, 3-, and 6-months postenrollment. The primary outcome was self-reported 7-day point prevalence of cigarette abstinence (PPA) at the 6-month follow-up. Secondary outcomes included reduction in cigarette smoking (excluding quitters), the number of cessation attempts, and the level of readiness to quit. RESULTS The self-reported 7-day PPA was statistically significantly lower among HTP users than among non-HTP users after 6 months (19.0% vs. 34.2%; p = 0.009), with an adjusted relative risk of 0.47 (95% confidence interval: 0.24-0.91; p = 0.03). The study identified no significant differences in secondary outcomes between the two groups. CONCLUSIONS Youth HTP users were less likely to abstain from tobacco use than their non-HTP-using counterparts. These results suggest that HTPs should not be promoted as smoking cessation or reduction aids among the youth population.
Collapse
Affiliation(s)
- Wei Xia
- School of Nursing, Sun Yat-Sen University, RM 613, 4/F, Block of School of Nursing, Sun Yat-Sen University North Campus, No. 74, 2nd Yat-Sen Rd, Yuexiu District, Guangzhou City, Guangdong Province, China; School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - William Ho Cheung Li
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Yuan Hui Luo
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Ting Na Liang
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Laurie Long Kwan Ho
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Ankie Tan Cheung
- School of Nursing, The University of Hong Kong, 4/F, William M. W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Peige Song
- School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou 310058, China; Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, United Kingdom.
| |
Collapse
|
6
|
Xia W, Li WHC, Liang T, Luo Y, Ho LLK, Cheung AT, Song P. Adaptation and Psychometric Evaluation of the Chinese Counseling Competencies Scale-Revised. Front Psychol 2021; 12:688539. [PMID: 34234724 PMCID: PMC8255382 DOI: 10.3389/fpsyg.2021.688539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study conducted a linguistic and psychometric evaluation of the Chinese Counseling Competencies Scale-Revised (CCS-R). Methods: The Chinese CCS-R was created from the original English version using a standard forward-backward translation process. The psychometric properties of the Chinese CCS-R were examined in a cohort of 208 counselors-in-training by two independent raters. Fifty-three counselors-in-training were asked to undergo another counseling performance evaluation for the test-retest. The confirmatory factor analysis (CFA) was conducted for the Chinese CCS-R, followed by internal consistency, test-retest reliability, inter-rater reliability, convergent validity, and concurrent validity. Results: The results of the CFA supported the factorial validity of the Chinese CCS-R, with adequate construct replicability. The scale had a McDonald's omega of 0.876, and intraclass correlation coefficients of 0.63 and 0.90 for test-retest reliability and inter-rater reliability, respectively. Significantly positive correlations were observed between the Chinese CCS-R score and scores of performance checklist (Pearson's γ = 0.781), indicating a large convergent validity, and knowledge on drug abuse (Pearson's γ = 0.833), indicating a moderate concurrent validity. Conclusion: The results support that the Chinese CCS-R is a valid and reliable measure of the counseling competencies. Practice implication: The CCS-R provides trainers with a reliable tool to evaluate counseling students' competencies and to facilitate discussions with trainees about their areas for growth.
Collapse
Affiliation(s)
- Wei Xia
- School of Nursing, Sun Yat-Sen University, Guangzhou, China.,School of Nursing, The University of Hong Kong, Hong Kong, China
| | | | - Tingna Liang
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Yuanhui Luo
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | | | - Ankie Tan Cheung
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Peige Song
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.,Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
7
|
Ho LLK, Li WHC, Cheung AT, Xia W, Lam TH. Awareness and Use of Heated Tobacco Products among Youth Smokers in Hong Kong: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8575. [PMID: 33227929 PMCID: PMC7699292 DOI: 10.3390/ijerph17228575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022]
Abstract
The growing popularity of heated tobacco products (HTPs) among youth may act as a gateway for smoking and jeopardize youth health. We aimed to describe the use of HTPs among youth smokers in Hong Kong and examine their risk awareness of HTPs as well as awareness of the proposed legislation. We conducted retrospective data analyses on the Youth Quitline Cohort (n = 731). We extracted participants' sociodemographic data, smoking profiles, and HTP use from 1 January 2017. Participants' HTP use increased from 5.7% in 2017 to 37.9% in 2020. Among the 731 participants, 175 were HTP users and 556 were HTP nonusers. Compared with nonusers, a significantly higher proportion of HTP users had tried using other tobacco products at least once. The most common reason for using HTPs was curiosity. HTP users were more likely than nonusers to misclassify HTPs as e-cigarettes; agree that HTPs were healthier and contained fewer harmful substances than conventional cigarettes; consider HTPs as a smoking cessation aid; and believe that HTPs could reduce conventional cigarette consumption. Overall, 61.2% of youth smokers disagreed with banning HTPs. Risk awareness of HTPs among youth might affect their likelihood of using these products. Stricter regulations on advertising and intensive health education are imperative to avoid misleading information and limit youth exposure to such harmful products.
Collapse
Affiliation(s)
- Laurie Long Kwan Ho
- School of Nursing, University of Hong Kong, Hong Kong, China; (L.L.K.H.); (A.T.C.); (W.X.)
| | - William Ho Cheung Li
- School of Nursing, University of Hong Kong, Hong Kong, China; (L.L.K.H.); (A.T.C.); (W.X.)
| | - Ankie Tan Cheung
- School of Nursing, University of Hong Kong, Hong Kong, China; (L.L.K.H.); (A.T.C.); (W.X.)
| | - Wei Xia
- School of Nursing, University of Hong Kong, Hong Kong, China; (L.L.K.H.); (A.T.C.); (W.X.)
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China;
| |
Collapse
|
8
|
Impact of COVID-19 on the Hong Kong Youth Quitline Service and Quitting Behaviors of Its Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228397. [PMID: 33202764 PMCID: PMC7696005 DOI: 10.3390/ijerph17228397] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/04/2020] [Accepted: 11/12/2020] [Indexed: 01/08/2023]
Abstract
Tobacco use is a possible risk factor for contracting and spreading COVID-19. We aimed to describe the impact of the COVID-19 pandemic on the Youth Quitline service and quitting behaviors of its users in Hong Kong. We conducted a telephone survey involving 201 participants of the Youth Quitline service, and retrospectively analyzed the operation and use of Quitline since the COVID-19 outbreak in Hong Kong. The number of incoming calls to the Youth Quitline and the participants' quit rate has increased since the COVID-19 outbreak in Hong Kong. Many participants (68%) did not realize that tobacco use potentially increased their risk for developing and spreading COVID-19; however, 43% agreed that the pandemic motivated their intention to quit, and 83% changed their smoking habits during the pandemic. These changes were mainly due to wearing masks (30%), closure of bars/pubs (25%), suspension of classes (14%), and being unable to socialize with friends (24%). Overall, 58% reduced their tobacco use; of these participants, 66% reported a ≥50% reduction in daily cigarette consumption. The participants reduced their smoking during the COVID-19 pandemic despite lacking knowledge about the potentially increased risk for contracting COVID-19 from continued smoking. The pandemic could create new opportunities to motivate young smokers to quit smoking, especially those seeking support for smoking cessation, and may further contribute to reducing the risks posed by COVID-19.
Collapse
|
9
|
Weng X, Wang MP, Li HCW, Cheung YTD, Lau CY, Kwong ACS, Lai VWY, Chan SSC, Lam TH. Effects of active referral combined with a small financial incentive on smoking cessation: study protocol for a cluster randomised controlled trial. BMJ Open 2020; 10:e038351. [PMID: 33109654 PMCID: PMC7592296 DOI: 10.1136/bmjopen-2020-038351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Evidence-based smoking cessation treatments are effective but underutilised, accentuating the need for novel approaches to increase use. This trial investigates the effects of active referral combined with a financial incentive to use smoking cessation services on smoking abstinence among community smokers. METHODS AND ANALYSIS This ongoing study is a two-arm, assessor-blinded, pragmatic, cluster randomised controlled trial with follow-ups at 1, 2, 3 and 6 months after randomisation. We aim to enrol 1134 daily smokers from 70 community sites (clusters) in Hong Kong. All participants receive Ask, Warn, Advise, Refer, Do-it-again (AWARD) guided advice and a self-help booklet at baseline. Additionally, participants in the intervention group receive an offer of referral to smoking cessation services at baseline and a small financial incentive (HK$300≈US$38) contingent on using any of such services within 3 months. The primary outcomes are bioverified abstinence (exhaled carbon monoxide <4 ppm and salivary cotinine <10 ng/mL) at 3 and 6 months. Secondary outcomes include self-reported 7-day point prevalence of abstinence, smoking reduction rate, quit attempts and the use of smoking cessation services at 3 and 6 months. Intention-to-treat approach and regression models will be used in primary analyses. ETHICS AND DISSEMINATION This protocol has been approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (IRB reference number: UW 18-318). The results of this trial will be submitted for publication in peer-reviewed journals, and the key findings will be presented at national and international conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry NCT03565796.
Collapse
Affiliation(s)
- Xue Weng
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China
| | | | | | - Ching Yin Lau
- School of Nursing, University of Hong Kong, Hong Kong, China
| | | | | | | | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
| |
Collapse
|
10
|
Weng X, Luk TT, Suen YN, Wu Y, Li HCW, Cheung YTD, Kwong ACS, Lai VWY, Chan SSC, Lam TH, Wang MP. Effects of simple active referrals of different intensities on smoking abstinence and smoking cessation services attendance: a cluster-randomized clinical trial. Addiction 2020; 115:1902-1912. [PMID: 32149425 DOI: 10.1111/add.15029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/06/2020] [Accepted: 02/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Proactive brief cessation advice by a lay counsellor combined with a referral to a smoking cessation service (active referral) is effective in increasing service use and quitting in community smokers. We compared the effect of two modified approaches to referrals on the cessation outcomes in community smokers. DESIGN Three-arm cluster-randomized trial. SETTING General community in Hong Kong. PARTICIPANTS Daily cigarette smokers (n = 1163; 77.7% male). INTERVENTIONS Participants were randomized to receive on-site active referral (OSR, n = 395), where lay counsellors helped participants make appointments with a smoking cessation service of their choice plus tailored reminders; mobile text messaging referral (TMR, n = 385), where participants were encouraged to use a smoking cessation service via text messages; or brief cessation advice only (control, n = 383). MEASUREMENTS The primary outcome was a self-reported 7-day point-prevalence abstinence at 6 months post-treatment initiation. Secondary outcomes included 7-day point-prevalence abstinence at 3 and 18 months, biochemically validated abstinence, smoking reduction and the use of cessation services at 3, 6 and 18 months. FINDINGS Using intention-to-treat analysis, the OSR (17.7%) and TMR (17.1%) groups had significantly higher self-reported abstinence than the control (12.0%) group at 6 months [odds ratio (OR) for OSR versus control = 1.58, 95% confidence interval (CI) = 1.06-2.36; OR for TMR versus control = 1.52, 95% CI = 1.01-2.28; both P < 0.05]. The corresponding validated abstinence rates at 6 months were 7.6, 7.8 and 3.9% (OR for TMR versus control = 2.02, 95% CI = 1.07-3.81; OR for TMR versus control = 2.07, 95% CI = 1.10-3.92; both P < 0.05). Self-reported and validated abstinence were similar at 18 months. OSR groups had higher rates of smoking cessation service use than the control group at all follow-ups (all P < 0.001). The smoking reduction rates were similar in continuing smokers. CONCLUSIONS Simple active referrals (in person or via text messaging) to smoking cessation services increased abstinence rates among smokers in Hong Kong compared with general brief cessation advice. On-site active referral increased the use of smoking cessation services compared with general brief cessation advice.
Collapse
Affiliation(s)
- Xue Weng
- School of Nursing, the University of Hong Kong, Pokfulam, Hong Kong
| | - Tzu Tsun Luk
- School of Nursing, the University of Hong Kong, Pokfulam, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, the University of Hong Kong, Pokfulam, Hong Kong
| | - Yongda Wu
- School of Nursing, the University of Hong Kong, Pokfulam, Hong Kong
| | | | | | | | | | | | - Tai-Hing Lam
- School of Public Health, the University of Hong Kong, Pokfulam, Hong Kong
| | - Man Ping Wang
- School of Nursing, the University of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|
11
|
Ho KY, Li WHC, Lam KKW, Wang MP, Xia W, Ho LY, Ho LLK, Lam TH, Chan SSC. Promoting smoking cessation among community-living female smokers by training smoking cessation and reduction ambassadors. J Public Health (Oxf) 2020; 42:53-61. [PMID: 30608601 DOI: 10.1093/pubmed/fdy223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/18/2018] [Accepted: 12/08/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Females are less willing than males to seek help from smoking cessation services; the present study examined how the use of these services by females could be enhanced by training young female ambassadors to deliver a brief intervention. METHODS We collaborated with the Hong Kong Girl Guides Association. Fifty of the association's Girl Guides served as smoking cessation and reduction ambassadors to deliver a brief intervention to at least two female smokers. The effectiveness of the intervention was evaluated by a one-group pre-test and repeated post-test design. We undertook data collection at baseline and at 1, 3 and 6 months. RESULTS In all, 106 female smokers received the brief intervention. At 6-month follow-up, the self-reported abstinence was 12.2%; the biochemically verified prevalence of quitting was 5.7%. Approximately 7% of participants were motivated to use smoking cessation services between baseline and 6 months. CONCLUSIONS This study supports the effectiveness of a brief intervention in promoting smoking cessation for community-living female smokers in Hong Kong. However, the intervention could be enhanced by further promoting the use of smoking cessation services to female smokers.
Collapse
Affiliation(s)
- Ka Yan Ho
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - William Ho Cheung Li
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Katherine Ka Wai Lam
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Wei Xia
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Lok Yin Ho
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Laurie Long Kwan Ho
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, G/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, China
| | - Sophia Siu Chee Chan
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| |
Collapse
|
12
|
Adolescent Smoking in Hong Kong: Prevalence, Psychosocial Correlates, and Prevention. J Adolesc Health 2019; 64:S19-S27. [PMID: 31122545 DOI: 10.1016/j.jadohealth.2019.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 11/24/2022]
Abstract
Preventing adolescent smoking is important as smoking is typically initiated by young people. This article reviews the prevalence, psychosocial correlates, and prevention of smoking in Hong Kong adolescents. The past 30-day smoking prevalence in adolescents decreased from 9.6% in 2003 to 2.5% in 2017. Tobacco advertisements, parental and best friends smoking, nonintact families, poor family relationships, lower socioeconomic status, being a new immigrant, poor knowledge of smoking-related harm, positive attitudes toward smoking, overestimation of peer smoking, and depressive symptoms were positively associated with smoking outcomes, whereas positive youth development, authoritative mother and permissive father, family functioning, school competence, and stronger tobacco industry denormalization beliefs were protective against smoking. Along with tobacco tax increase, ban on tobacco advertisements, smoke-free law and pictorial warnings, educational efforts through theater performances, social norms campaigns, and positive adolescent training programs have been conducted to prevent adolescent smoking. To achieve the ultimate goal of tobacco endgame, further tax increase, plain packaging, banning point-of-sale display of tobacco products, smoke-free area extension, and raising minimum age of purchase should be implemented. The government proposed law to ban e-cigarettes, and heated tobacco products should be passed soon to protect children and adolescents from using these products.
Collapse
|
13
|
Luk TT, Li WHC, Cheung DYT, Wong SW, Kwong ACS, Lai VWY, Chan SSC, Lam TH, Wang MP. Chat-based instant messaging support combined with brief smoking cessation interventions for Chinese community smokers in Hong Kong: Rationale and study protocol for a pragmatic, cluster-randomized controlled trial. Contemp Clin Trials 2019; 77:70-75. [PMID: 30593882 DOI: 10.1016/j.cct.2018.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/17/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Novel approaches to engage community smokers in smoking cessation are needed as smokers typically lack motivation to quit or use evidence-based tobacco dependence treatment. Mobile instant messaging apps (e.g., WhatsApp, Facebook Messenger) are widely used but under-studied as a mobile health modality for delivering smoking cessation support. This paper presents the rationale and study design of a trial which aims to evaluate the effectiveness of a chat-based intervention using mobile instant messaging combined with brief interventions for community smokers. METHODS This is a two-arm, parallel, accessor-blinded, pragmatic cluster-randomized controlled trial on an estimated 1172 daily cigarette smokers aged ≥18 years proactively recruited from 68 community sites (cluster) throughout Hong Kong. Subjects in intervention group received three months of chat-based, instant messaging support guided by acceptance and commitment therapy and other behavioural change techniques, integrated with brief advice and active referral to a smoking cessation service using the AWARD (Ask, Warn, Advise, Refer, Do-it-again) intervention model. Control group received brief advice to quit plus a self-help booklet at baseline. Outcomes were assessed at 1-, 2-, 3- and 6-month after baseline. The primary outcome is abstinence validated by exhaled carbon monoxide (<4 ppm) and salivary cotinine (<10 ng/mL) at 6-month after baseline. Primary analyses will be based on intention-to-treat. COMMENTS This is the first trial examining the effectiveness of a chat-based cessation support programme combined with brief interventions in promoting abstinence. The intervention model can be adapted for other behavioural change treatments and more advanced digital smoking cessation intervention.
Collapse
Affiliation(s)
- Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | | | - Sze Wing Wong
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | | | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong.
| |
Collapse
|
14
|
Ho KY, Li WHC, Wang MP, Lam KKW, Lam TH, Chan SSC. Comparison of two approaches in achieving smoking abstinence among patients in an outpatient clinic: A Phase 2 randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2018; 101:885-893. [PMID: 29439844 DOI: 10.1016/j.pec.2018.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/19/2018] [Accepted: 02/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To compare the effectiveness of quitting immediately and cutting down to quit in promoting smoking abstinence among smokers in an outpatient clinic. METHODS A total of 100 subjects were randomized into two groups, 50 in the quit immediately group, who received an intervention on abruptly quitting, and 50 in the cut down to quit group, who received an intervention on gradual reduction. All subjects were followed up at 6 and 12 months via telephone. The intention-to-treat principle was used. RESULTS At the 6-month follow-up, the self-reported quit rate of subjects in the quit immediately group was significantly higher than in the cut down to quit group (18.0% vs. 4.0%, p = 0.04). However, this difference was not significant at the 12-month follow-up (12.0% vs. 4.0%, p = 0.16). CONCLUSION These data suggest that quitting immediately might be more effective than cutting down to quit at 6 months but not at 12 months. PRACTICE IMPLICATIONS It is crucial to allow smokers to select quitting immediately or reducing the number of cigarettes smoked. Further studies are warranted to compare the effectiveness of various approaches for achieving smoking abstinence.
Collapse
Affiliation(s)
- K Y Ho
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong.
| | - William H C Li
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong.
| | - M P Wang
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong.
| | - K K W Lam
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong.
| | - T H Lam
- School of Public Health, The University of Hong Kong, HKSAR, Hong Kong
| | - Sophia S C Chan
- School of Nursing, The University of Hong Kong, HKSAR, Hong Kong.
| |
Collapse
|
15
|
Ho KY, Li HCW, Lam KKW, Chan SSC, Wang MP, Chan VWF, Xia VW, Lam TH. Exploratory study on the relationship between smoking and other risk behaviours among young smokers. J Clin Nurs 2018; 27:2859-2867. [PMID: 29633459 DOI: 10.1111/jocn.14375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the relationship between smoking and other risk behaviours among Chinese young people in Hong Kong. BACKGROUND There is growing concern about coexisting risk behaviours in young smokers. Information about smoking and other risk behaviours is crucial for developing interventions to promote smoking abstinence and adoption of healthy lifestyles. The relationship between smoking and other risk behaviours among Chinese young people in Hong Kong has not been explored. DESIGN This is a mixed-method retrospective population-based study. METHODS A retrospective population-based study was conducted with 1,147 young smokers through Youth Quitline between November 2011-July 2016. Attitudes, behaviours and experiences related to smoking and risk behaviours among Chinese young smokers were examined in semi-structured qualitative interviews with 30 participants randomly selected from the retrospective population-based study. RESULTS In total, 45.5% participants reported engaging in at least one other risk behaviour. The interviews revealed that drinking alcohol may have a significant impact on quitting smoking. In addition, smoking may be a gateway for more serious risk behaviours during adolescence. Low health awareness may explain the unhealthy lifestyles among young smokers. CONCLUSIONS This study bridges a gap in existing literature by exploring relationships between smoking and other risk behaviours among young people in Hong Kong. RELEVANCE TO CLINICAL PRACTICE Given the interrelationships between smoking and other risk behaviours, a holistic approach should be used to promote smoking cessation and healthy lifestyles among young smokers. If young smokers improve their health and quit smoking at the same time, their physical and mental development will benefit as a secondary outcome.
Collapse
Affiliation(s)
- Ka Yan Ho
- School of Nursing, University of Hong Kong, Pokfulam, Hong Kong
| | | | | | | | - Man Ping Wang
- School of Nursing, University of Hong Kong, Pokfulam, Hong Kong
| | | | - Viveka Wei Xia
- School of Nursing, University of Hong Kong, Pokfulam, Hong Kong
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|
16
|
Wang MP, Suen YN, Li WHC, Lam COB, Wu SYD, Kwong ACS, Lai VW, Chan SS, Lam TH. Intervention With Brief Cessation Advice Plus Active Referral for Proactively Recruited Community Smokers: A Pragmatic Cluster Randomized Clinical Trial. JAMA Intern Med 2017; 177:1790-1797. [PMID: 29059277 PMCID: PMC5820734 DOI: 10.1001/jamainternmed.2017.5793] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Most smoking cessation (SC) clinics are costly, passive, and underused. OBJECTIVE To compare the SC effect of a combined intervention involving brief, model-guided SC advice plus active referral to SC services (active referral group) with those of brief, model-guided SC advice only (brief advice group) and general SC advice only (control group). DESIGN, SETTING, AND PARTICIPANTS A single-blind, 3-arm, pragmatic cluster randomized clinical trial was conducted including 1226 adult daily smokers in the general Hong Kong community proactively recruited to participate in the Quit-to-Win Contest held in 2015. The study was conducted from June 20 to September 24, 2015. Participants were randomly allocated to the active referral (n = 402), brief advice (n = 416), and control (n = 408) groups. Intention-to-treat analysis was used. INTERVENTIONS Brief telephone counseling was offered to the active referral and brief advice groups at 1 and 2 months. Interventions were delivered by SC ambassadors who had undergone a short training period. MAIN OUTCOMES AND MEASURES The primary outcome was the self-reported past 7-day point prevalence of abstinence (PPA) at 6 months. The secondary outcomes were carbon monoxide level-validated abstinence, smoking reduction, and SC service use. RESULTS Participants included 991 (80.8%) men; mean (SD) age was 42.0 (14.8) years. The response rate was 68.2% at 3 and 72.3% at 6 months. The corresponding PPAs were 18.9% and 17.2% in the active referral group-higher than in the brief advice (8.9% and 9.4%; both P ≤ .001) or control (14.0% and 11.5%; P = .03 at 6 months) groups. Compared with the other 2 groups, the active referral group had significantly higher validated abstinence rates (10.2% at 3 months and 9.0% at 6 months, all P < .05) with odds ratios of 2.84 (95% CI, 1.57-5.15) and 2.61 (95% CI, 1.46-4.68) at 3 months, and 1.85 (95% CI, 1.06-3.23) and 1.81 (95% CI, 1.04-3.16) at 6 months in the brief advice and control groups, respectively. The SC service use rate was significantly higher in the active referral group (25.1%) than in either brief advice (2.4%) or control (3.4%) groups at 6 months (P < .001). CONCLUSIONS AND RELEVANCE An intervention involving brief advice and active referral delivered to smokers in the community by volunteers can increase quitting in places where SC services are available but underused. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02539875.
Collapse
Affiliation(s)
- Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | | | | | | | | | - Vienna W Lai
- Hong Kong Council on Smoking and Health, Hong Kong
| | - Sophia S Chan
- School of Nursing, University of Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong
| |
Collapse
|
17
|
Electronic cigarette use is not associated with quitting of conventional cigarettes in youth smokers. Pediatr Res 2017; 82:14-18. [PMID: 28355200 DOI: 10.1038/pr.2017.80] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/11/2017] [Indexed: 12/31/2022]
Abstract
BackgroundTo investigate the association between electronic cigarette (e-cig) use and smoking cessation among smokers who called the Youth Quitline in Hong Kong.MethodsThis longitudinal study collected data on youth smokers' (N=189) use and perception of e-cigs, conventional cigarette smoking behavior, and sociodemographic characteristics at baseline. Self-reported past 7-day point prevalence of abstinence (PPA) was assessed in the 6-month telephone follow-up. Linear and logistic regressions were used to estimate the association of e-cig use with quitting cigarette smoking and other cessation-related outcomes.ResultsE-cig users were younger, more addicted to nicotine, and less ready to quit (all P<0.05) at baseline. The PPA rate was lower in e-cig users (13.4% vs. 20.8%) at follow-up. E-cig use was not associated with PPA at the 6-month follow-up (odds ratio (OR): 0.56, 95% CI: 0.24 to 1.35), but it was nonsignificantly related to more cessation attempts (raw coefficient (b): 1.26, 95% CI: -0.13 to 2.66). Among those who still smoked, e-cig use was nonsignificantly associated with intention to quit smoking (OR: 0.55, 95% CI: 0.15 to 2.05), nicotine dependence (Fagerström score, b: 0.75, 95% CI: -0.39 to 1.90), and perceptions on quitting cigarette smoking.ConclusionE-cig use was not associated with successful smoking cessation among Youth Quitline smokers.
Collapse
|