Interest in treatments to stop smoking

Cognitive Distortions as Barriers to Seeking Smoking Cessation Treatment: A Comparative Study

Background/Objectives: Despite the availability of effective pharmacotherapy and evidence-based treatments, a substantial proportion of smokers do not seek treatment. This study aims to explore the cognitive distortions associated with not seeking evidence-based smoking cessation treatment and to identify cognitive barriers. Methods: The research conducted in Istanbul between October and December 2017 employs a cross-sectional design and includes two groups: a treatment-seeking group comprising 156 patients diagnosed with tobacco use disorder and a non-treatment seeking group of 78 patients with tobacco use disorder who had never sought professional help for smoking cessation. A comprehensive data collection process was used, including sociodemographic information, cognitive distortion assessment using the cognitive distortions scale, a smoking-related cognitive distortions interview and the Fagerström Test for Nicotine Dependence. Results: While no significant sociodemographic differences were observed between the treatment-seeking and non-treatment-seeking groups, the study found that higher nicotine dependence was associated with a higher likelihood of seeking treatment. The treatment-seeking group displayed significantly higher levels of "all-or-nothing thinking" cognitive distortions related to smoking and smoking cessation. Conversely, the non-treatment-seeking group exhibited elevated levels of cognitive distortions such as "labeling", "mental filtering", "should statements" and "minimizing the positive" regarding receiving smoking cessation treatment. Conclusions: Understanding the cognitive distortions associated with treatment-seeking behavior for tobacco use disorder is crucial for developing targeted public-based interventions, public service announcements for tobacco use prevention and encouraging individuals to seek evidence-based treatment. Addressing these cognitive distortions can also potentially enhance the effectiveness of smoking cessation programs and reduce the global burden of tobacco-related diseases and mortality.

Theoretical components of smoking cessation interventions for persons with physical disabilities: A scoping review

Rationale Persons with physical disabilities report higher cigarette smoking rates and a lower likelihood of accessing health services (e.g., smoking cessation services). Explicit and systematic application of behaviour change theory may be a promising approach to addressing these inequities and developing impactful smoking cessation interventions for persons with physical disabilities.

OBJECTIVE

This scoping review aimed to explore how behaviour change theory and intervention components have been used to design smoking cessation interventions for persons with physical disabilities.

METHODS

Electronic databases (Medline, Embase, PsycINFO, CINAHL, Web of Science) were systematically searched. Smoking cessation interventions for persons with physical disabilities were identified. Behaviour change theory and intervention components, including behaviour change techniques, intervention functions, mode of delivery, intervention source, and setting, were extracted from the included articles.

RESULTS

Among the eleven included articles, there were nine unique smoking cessation interventions for persons with physical disabilities. Three interventions mentioned theory, but none of these articles explicitly applied or tested the theory. Intervention components were consistently combined to deliver pharmacotherapy and behavioural counselling-based interventions.

CONCLUSION

The results of this review highlight the scarcity of theory-based smoking cessation interventions for persons with physical disabilities. While the interventions were not theory-based, they were evidence-based and aligned with recommendations for smoking cessation treatment (i.e., behavioural counselling plus pharmacotherapy). Future research should take a theory-based approach to intervention development to enhance the likelihood that smoking cessation interventions for persons with physical disabilities are effective, replicable, and equitable.

History and Correlates of Smoking Cessation Behaviors Among Smokers With Serious Mental Illness

INTRODUCTION

Individuals with serious mental illness (SMI) smoke at rates two to three times greater than the general population but are less likely to receive treatment. Increasing our understanding of correlates of smoking cessation behaviors in this group can guide intervention development.

AIMS AND METHODS

Baseline data from an ongoing trial involving smokers with SMI (N = 482) were used to describe smoking cessation behaviors (ie, quit attempts, quit motivation, and smoking cessation treatment) and correlates of these behaviors (ie, demographics, attitudinal and systems-related variables).

RESULTS

Forty-three percent of the sample did not report making a quit attempt in the last year, but 44% reported making one to six quit attempts; 43% and 20%, respectively, reported wanting to quit within the next 6 months or the next 30 days. Sixty-one percent used a smoking cessation medication during their quit attempt, while 13% utilized counseling. More quit attempts were associated with lower nicotine dependence and carbon monoxide and greater beliefs about the harms of smoking. Greater quit motivation was associated with lower carbon monoxide, minority race, benefits of cessation counseling, and importance of counseling within the clinic. A greater likelihood of using smoking cessation medications was associated with being female, smoking more cigarettes, and receiving smoking cessation advice. A greater likelihood of using smoking cessation counseling was associated with being male, greater academic achievement, and receiving smoking cessation advice.

CONCLUSIONS

Many smokers with SMI are engaged in efforts to quit smoking. Measures of smoking cessation behavior are associated with tobacco use indicators, beliefs about smoking, race and gender, and receiving cessation advice.

IMPLICATIONS

Consideration of factors related to cessation behaviors among smokers with SMI continues to be warranted, due to their high smoking rates compared to the general population. Increasing our understanding of these predictive characteristics can help promote higher engagement in evidence-based smoking cessation treatments among this subpopulation.

'Very brief advice' (VBA) on smoking in family practice: a qualitative evaluation of the tobacco user's perspective

BACKGROUND

Very Brief Advice on smoking (VBA) is an evidence-based intervention designed to increase quit attempts among patients who smoke. VBA has been widely disseminated in general practice settings in the United Kingdom, however its transferability to Southern European settings is not well established. This study sought to document the perspectives of Greek general practice patients in terms of the acceptability and satisfaction with receiving VBA from their general practitioner (GP) and its influence on patients' motivation to make a quit attempt. We also examine patient identified barriers and facilitators to acting on VBA.

METHODS

Semi-structured interviews were conducted with 50 patients who reported current tobacco use recruited from five general practices in Crete, Greece. All patients received VBA from their GP and interviews were conducted immediately after the GP appointment. Thematic analysis was used to analyze data.

RESULTS

The majority of patients were satisfied with the VBA intervention. Approximately one quarter of patients reported they were motivated to make an attempt to quit smoking after receiving VBA from their GP. Patients identified a clear preference for VBA to be delivered in a supportive manner, which communicated genuine concern versus fear-based approaches. Patients with an existing smoking-related illness were more likely to report plans to act on their GP's VBA. Patients not ready to quit smoking indicated they would be likely to seek the support of their GP for future quit attempts as a result of VBA. Many patients reported low self-efficacy with quitting and apprehension about available quit smoking supports.

CONCLUSIONS

VBA was positively received by the majority of smokers interviewed. Participating patients confirmed the motivational role of advice when delivered in a supportive and caring manner. Personal health status, beliefs about quit smoking supports, and low self-efficacy appear to influence patient's motivation to make an aided quit attempt.

Smoking and social anxiety: the role of false safety behaviors

Despite the negative health consequences associated with smoking, most smokers find it difficult to quit. This is especially true for smokers with elevated social anxiety. One factor that may play a role in maintaining smoking with elevated anxiety is false safety behavior (FSB), behaviors geared toward decreasing anxiety short-term but that maintain or increase anxiety long-term. The present study tested whether FSB explained the relation of social anxiety severity with smoking among 71 current smokers. Avoidance-related FSB was the only type of FSB related to cigarettes smoked per day (CPD) and it was robustly related to more CPD. Further, social anxiety was related to CPD indirectly via FSB-Avoidance. Findings suggest that more frequent use of avoidance behaviors to manage anxiety may maintain smoking and may partially explain the high rates of smoking among those with elevated social anxiety. Thus, FSB may be a promising target in smoking cessation interventions, especially among those with elevated social anxiety.

An exploration of the barriers to attendance at the English Stop Smoking Services

Introduction

Despite the availability of effective stop smoking assistance, most smokers do not utilise formal cessation programmes such as the English Stop Smoking Services (SSS). We modified the Treatment Barriers Questionnaire (TBQ), developed in the USA, and distributed it to a sample of English smokers to explore the most important barriers to the use of the SSS.

Methods

Participants of Start2quit, a randomised controlled trial aiming to increase attendance at the SSS using tailored risk information and 'taster' sessions, who reported at follow-up that they had not attended the SSS, were asked to complete the TBQ; 672 (76.9% response rate) were retained for analysis. Principal Component Analysis (PCA) was conducted to examine the structure of the data. Multiple linear regressions were used to determine whether any participant characteristics were associated with particular barriers.

Results

The most commonly endorsed items related to a lack of information on and a lack of confidence in the efficacy of the SSS. PCA yielded seven factors: Work and time constraints (Factor1); Smokers should quit on their own (Factor2); Nothing can help in quitting smoking(Factor3); Disinterest in quitting (Factor4); Lack of social support to attend (Factor5); Lack of privacy at programmes (Factor6); Lack of information and perceived availability (Factor7). Age was associated with Factors 1, 3 and 4, motivation to quit with Factors 2 and 4, and confidence in quitting with Factors 1, 2, and 3.

Conclusions

The findings suggest that many barriers exist, and they vary according to smoker demographics and characteristics, pointing to the need for tailored recruitment strategies.

Trial registration

ISRCTN76561916.

Start2quit: a randomised clinical controlled trial to evaluate the effectiveness and cost-effectiveness of using personal tailored risk information and taster sessions to increase the uptake of the NHS Stop Smoking Services

BACKGROUND

The NHS Stop Smoking Services (SSSs) offer help to smokers who want to quit. However, the proportion of smokers attending the SSSs is low and current figures show a continuing downward trend. This research addressed the problem of how to motivate more smokers to accept help to quit.

OBJECTIVES

To assess the relative effectiveness, and cost-effectiveness, of an intervention consisting of proactive recruitment by a brief computer-tailored personal risk letter and an invitation to a 'Come and Try it' taster session to provide information about the SSSs, compared with a standard generic letter advertising the service, in terms of attendance at the SSSs of at least one session and validated 7-day point prevalent abstinence at the 6-month follow-up.

DESIGN

Randomised controlled trial of a complex intervention with follow-up 6 months after the date of randomisation.

SETTING

SSSs and general practices in England.

PARTICIPANTS

All smokers aged ≥ 16 years identified from medical records in participating practices who were motivated to quit and who had not attended the SSS in the previous 12 months. Participants were randomised in the ratio 3 : 2 (intervention to control) by a computer program.

INTERVENTIONS

Intervention - brief personalised and tailored letter sent from the general practitioner using information obtained from the screening questionnaire and from medical records, and an invitation to attend a taster session, run by the local SSS. Control - standard generic letter from the general practice advertising the local SSS and the therapies available, and asking the smoker to contact the service to make an appointment.

MAIN OUTCOME MEASURES

(1) Proportion of people attending the first session of a 6-week course over a period of 6 months from the receipt of the invitation letter, measured by records of attendance at the SSSs; (2) 7-day point prevalent abstinence at the 6-month follow-up, validated by salivary cotinine analysis; and (3) cost-effectiveness of the intervention.

RESULTS

Eighteen SSSs and 99 practices within the SSS areas participated; 4384 participants were randomised to the intervention (n = 2636) or control (n = 1748). One participant withdrew and 4383 were analysed. The proportion of people attending the first session of a SSS course was significantly higher in the intervention group than in the control group [17.4% vs. 9.0%; unadjusted odds ratio (OR) 2.12, 95% confidence interval (CI) 1.75 to 2.57; p < 0.001]. The validated 7-day point prevalent abstinence at the 6-month follow-up was significantly higher in the intervention group than in the control group (9.0% vs. 5.6%; unadjusted OR 1.68, 95% CI 1.32 to 2.15; p < 0.001), as was the validated 3-month prolonged abstinence and all other periods of abstinence measured by self-report. Using the National Institute for Health and Care Excellence decision-making threshold range of £20,000-30,000 per quality-adjusted life-year gained, the probability that the intervention was more cost-effective than the control was up to 27% at 6 months and > 86% over a lifetime horizon.

LIMITATIONS

Participating SSSs may not be representative of all SSSs in England. Recruitment was low, at 4%.

CONCLUSIONS

The Start2quit trial added to evidence that a proactive approach with an intensive intervention to deliver personalised risk information and offer a no-commitment introductory session can be successful in reaching more smokers and increasing the uptake of the SSS and quit rates. The intervention appears less likely to be cost-effective in the short term, but is highly likely to be cost-effective over a lifetime horizon.

FUTURE WORK

Further research could assess the separate effects of these components.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN76561916.

FUNDING DETAILS

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 3. See the NIHR Journals Library website for further project information.

Evaluation and Implementation of a Proactive Telephone Smoking Cessation Counseling for Parents: A Study Protocol of an Effectiveness Implementation Hybrid Design

Detrimental health consequences of smoking for both parents and children stress the importance for parents to quit. A Dutch efficacy trial supported the efficacy of proactive telephone counseling on parents. Still, how this program would function in "real world" conditions and how parents could be optimally reached is unclear. Therefore, this study will use an innovative method to examine the recruitment success of two implementation approaches (i.e., via a healthcare approach and a mass media approach) to test the (cost)effectiveness of the program. A two-arm randomized controlled trial and an implementation study (i.e., process evaluation) are conducted. Parents (N = 158) will be randomly assigned to the intervention (i.e., telephone counseling) or control conditions (i.e., self-help brochure). Primary outcome measure is 7-day point prevalence abstinence at three months post-intervention. Qualitative and quantitative research methods are used for the process evaluation. We expect that parents in the intervention condition have higher cessation rates than parents in the control condition. We also expect that the recruitment of parents via (youth) health care services is a more promising implementation approach compared to mass media. Results will have implications for the effectiveness of a proactive telephone counseling and provide directions for its successful implementation.

Treatment barriers among younger and older socioeconomically disadvantaged smokers

OBJECTIVES

Underutilization of smoking cessation treatments contributes to high rates of smoking in socioeconomically disadvantaged populations. Guided by a conceptual framework, the present study explored how healthcare provider factors, social environment characteristics, and cessation beliefs influence treatment utilization among low-income smokers and whether these associations vary by age.

STUDY DESIGN

Analyses were conducted on baseline data from 2406 participants enrolled in a randomized controlled trial that evaluated the effectiveness of a proactive outreach cessation intervention among a sample of younger (18-34 years) and older (35-64 years) smokers enrolled in public healthcare assistance programs.

METHODS

Multivariable logistic regression models predicted past year cessation treatment utilization (CTU) among younger and older smokers. Independent variables included measures of healthcare provider barriers, social environment characteristics, and cessation beliefs.

RESULTS

Younger smokers were less likely to have CTU than older smokers (27.2% vs 36.2%; P <.001). In both groups, number of cigarettes per day, more problems accessing healthcare, receiving medication-related cessation advice, and readiness to quit were positively associated with CTU (P <.05). Among younger smokers, living with another smoker was associated with lower odds of CTU while receipt of cessation advice was associated (P = .033) with higher odds of CTU.

CONCLUSIONS

In this sample of low-income smokers, interest in quitting was high but treatment utilization was low. Increasing utilization of cessation treatments via interventions that target issues specific to low-income smokers, including healthcare provider access and advice, the home environment, and motivation to quit, is an important step toward reducing smoking rates in this population.

Improving the continuity of smoking cessation care delivered by quitline services

OBJECTIVES

This study identified smokers' intended use of new quitline features aimed at improving smoking cessation such as having the same quitline advisor for each call, longer-term telephone counselling and provision of additional cessation treatments.

METHODS

Smokers who had previously used quitline counselling completed a computer-assisted telephone interview examining intended use of potential quitline enhancements.

RESULTS

The majority of smokers (61.1%) thought their chances of quitting would have increased a lot/moderately if they had the same quitline advisor for each call. Most smokers reported likely use of longer-term quitline telephone support after a failed (58.3%) or successful (60%) quit attempt. Smokers were likely to use quitline support long-term (mean=9.9 months). Most smokers would be likely to use free or subsidised nicotine replacement therapy (NRT) (74.9%) if offered by quitlines. Younger smokers had greater odds of being likely to use text messages, whereas less educated smokers had greater odds of being likely to use free or subsidised NRT.

CONCLUSIONS

Smokers appear interested in quitlines offering longer-term telephone support, increased continuity of care and additional effective quitting strategies.

PRACTICE IMPLICATIONS

Quitlines could adopt a stepped care model that involves increasingly intensive treatments and extended telephone counselling delivered by the same quitline advisor.

Is nicotine replacement therapy overvalued in smoking cessation? Analysis of smokers' and quitters' communication in social media

BACKGROUND

Internet discussion forums provide new, albeit less used data sources for exploring personal experiences of illness and treatment strategies.

OBJECTIVE

To gain an understanding of how discussion forum participants value nicotine replacement therapy (NRT) in smoking cessation (SC).

SETTING

Finnish national Internet-based discussion forum, STUMPPI, supporting SC and consisting of ten free discussion areas, each with a different focus. The analysis was based on STUMPPI forum participants' postings (n = 24 481) in five discussion areas during January 2007-January 2012.

DESIGN

Inductive content analysis of the postings concerning NRT use or comparing NRT to other SC methods.

RESULTS

Three major themes related to NRT in SC emerged from the discussions. These were as follows: (I) distrust and negative attitude towards NRT; (II) neutral acceptance of NRT as a useful SC method; and (III) trust on the crucial role of NRT and other SC medicines. The negative attitude was related to following perceptions: NRT use maintains tobacco dependence, fear of NRT dependence or experience of not gaining help from NRT use. NRT was perceived to be useful particularly in the initiation of SC attempts and in dealing with physiological dependence. The most highlighted factors of successful quitting were quitters' own psychological empowerment and peer support from the discussion community.

CONCLUSIONS

The majority of STUMPPI forum participants had low or balanced expectations towards the role of NRT in SC. More research from the smokers' and quitters' perspective is needed to assess the real value of NRT compared to other methods in SC.

Assessing the extent to which healthcare workers advised and assisted smokers to quit based on patient motivation levels

Smoking remains the leading cause of preventable death in the United States. Although healthcare workers play a key role in helping patients quit smoking, the degree to which they provide help varies. This study assesses the extent to which smokers report that their healthcare worker advised and assisted them with quitting based on their level of readiness to make a change. The 2006 Hawaii Adult Tobacco Survey asked questions regarding smoking status and if advice and assistance with quitting was given from a healthcare worker. Percentages for reporting healthcare worker's advice and assistance were compared among the three levels of motivational readiness using the chi-square test of association for 331 current, everyday smokers (56% women; 38% in the age group of 45-54 years). Most smokers are given advice to quit smoking. However, only about half of those motivated to quit are given assistance to do so. Most smokers across all motivation levels received advice to quit smoking with no significant difference between levels of readiness to quit. Less than half of smokers received any type of assistance with quitting smoking, with higher motivated smokers significantly receiving more assistance with cessation medication or nicotine replacement therapy and setting a quit date. This is a call to action for healthcare workers to address smoking with every patient. Adjustments to protocols for addressing smoking cessation and readiness to quit may be warranted.

Effectiveness of proactive quitline counselling for smoking parents recruited through primary schools: results of a randomized controlled trial

AIMS

To test the effectiveness of tailored quitline (telephone) counselling among smoking parents recruited into cessation support through their children's primary schools.

DESIGN

Two-arm randomized controlled trial with 3- and 12-month follow-up.

SETTING

Proactive telephone counselling was administered by the Dutch national quitline.

PARTICIPANTS

Smoking parents were recruited through their children's primary schools and received either intensive quitline support in combination with tailored supplementary materials (n = 256) or a standard self-help brochure (n = 256).

MEASUREMENTS

The primary outcome was 7-day point-prevalence abstinence at 12-month follow-up. Also measured were baseline characteristics, use of and adherence to nicotine replacement therapy and pharmacotherapy, smoking characteristics and implementation of a home smoking ban.

FINDINGS

Parents who received quitline counselling were more likely to report 7-day point-prevalence abstinence at 12-month assessment [34.0 versus 18.0%, odds ratio (OR) = 2.35, confidence interval (CI) = 1.56-3.54] than those who received a standard self-help brochure. Parents who received quitline counselling were more likely to use nicotine replacement therapy (P < 0.001) than those who received a standard self-help brochure. Among parents who did not achieve abstinence, those who received quitline counselling smoked fewer cigarettes at 3-month (P < 0.001) and 12-month assessment (P < 0.001), were more likely to make a quit attempt (P < 0.001), to achieve 24 hours' abstinence (P < 0.001) and to implement a complete home smoking ban (P < 0.01).

CONCLUSIONS

Intensive quitline support tailored to smoking parents is an effective method for helping parents quit smoking and promoting parenting practices that protect their children from adverse effects of smoking.

Documentation of the 5 as for smoking cessation by PCPs across distinct health systems

OBJECTIVES

Physicians can help patients quit smoking using the 5 As of smoking cessation. This study aimed to (1) identify the proportion of known smokers that receive smoking cessation services in the course of routine clinical practice; (2) describe demographic and comorbidity characteristics of patients receiving the 5 As in these systems; and (3) evaluate differences in performance of the 5 As across health systems, gender, and age categories.

STUDY DESIGN

Electronic medical records of 200 current smokers from 6 unique health systems (N = 1200) were randomly selected from 2006 to 2010. Primary care encounter progress notes were hand coded for occurrences of the 5 As.

METHODS

Bivariate comparisons of delivery of the 3 smoking-cessation services by site, gender, and age category were analyzed using χ² tests.

RESULTS

About 50% of smokers were advised to quit smoking, 39% were assessed for their readiness to quit, and 54% received some type of assistance to help them quit smoking. Only 2% had a documented plan for follow-up regarding their quitting efforts (arrange). Significant differences were found among sites for documentation of receiving the 5 As and between age groups receiving assistance with quitting. There was no statistically significant difference between genders in receipt of the 5 As.

CONCLUSIONS

Documentation of adherence to the 5 As varied by site and some demographics. Adjustments to protocols for addressing cessation and readiness to quit may be warranted. Health systems could apply the methodology described in this paper to assess their own performance, and then use that as a basis to guide improvement initiatives.

An efficient early phase 2 procedure to screen medications for efficacy in smoking cessation

RATIONALE

Initial screening of new medications for potential efficacy (i.e., Food and Drug Administration (FDA) early phase 2), such as in aiding smoking cessation, should be efficient in identifying which drugs do, or do not, warrant more extensive (and expensive) clinical testing.

OBJECTIVES

This focused review outlines our research on development, evaluation, and validation of an efficient crossover procedure for sensitivity in detecting medication efficacy for smoking cessation. First-line FDA-approved medications of nicotine patch, varenicline, and bupropion were tested as model drugs, in three separate placebo-controlled studies. We also tested specificity of our procedure in identifying a drug that lacks efficacy, using modafinil.

RESULTS

This crossover procedure showed sensitivity (increased days of abstinence) during week-long "practice" quit attempts with each of the active cessation medications (positive controls) versus placebo, but not with modafinil (negative control) versus placebo, as hypothesized. Sensitivity to medication efficacy signal was observed only in smokers high in intrinsic quit motivation (i.e., already preparing to quit soon) and not smokers low in intrinsic quit motivation, even if monetarily reinforced for abstinence (i.e., given extrinsic motivation).

CONCLUSIONS

A crossover procedure requiring less time and fewer subjects than formal trials may provide an efficient strategy for a go/no-go decision whether to advance to subsequent phase 2 randomized clinical trials with a novel drug. Future research is needed to replicate our results and evaluate this procedure with novel compounds, identify factors that may limit its utility, and evaluate its applicability to testing efficacy of compounds for treating other forms of addiction.

The impact of computed tomography screening for lung cancer on smoking behaviors: a teachable moment?

BACKGROUND

Helical computed tomography (CT) has emerged as a potential screening test for lung cancer. An important component of care surrounding the use of this technology is the impact of screening on decisions surrounding smoking cessation.

OBJECTIVE

The aim of this article was to conduct an integrative review of literature on the impact of lung cancer screening with CT on smoking behaviors of current smokers.

METHODS

Ganong's [Res Nurs Health. 1987;10(1):1-11] guidelines were used to conduct this integrative review. Computerized databases were used to identify relevant articles. Data were extracted from the studies, and then content analysis was used to synthesize the findings.

RESULTS

Nine studies were identified and reviewed. The quit rate among participants ranged from 6.6% to 42% after screening. Among current smokers, smoking abstinence was associated with older age, worse pulmonary function, and having multiple abnormal CT findings. Motivation to quit smoking, within the next 30 days, ranged from 14% to 35% among smokers. Factors associated with increased motivation were older age, lower nicotine addiction, fewer lung cancer symptoms, higher self-efficacy, and acknowledgment of the advantages of quitting smoking.

CONCLUSIONS

Participants undergoing lung cancer screening had increased motivation to quit smoking. Computed tomographic screening for lung cancer appears to be a teachable moment to address smoking cessation.

IMPLICATIONS FOR PRACTICE

Screening for lung cancer is only one step to fight lung cancer. Incorporating smoking cessation interventions along with the use of technology is necessary to fight this deadly disease.

Medicinal nicotine nonuse: smokers' rationales for past behavior and intentions to try medicinal nicotine in a future quit attempt

INTRODUCTION

Nicotine replacement therapy (NRT) is a proven smoking cessation treatment. Previous research has reported low rates of NRT use among quit attempters. This study analyzed population-level nonuse rates and reasons for not using NRT.

METHODS

Data were from the 2008 adult Colorado Tobacco Attitudes and Behaviors Survey (TABS), a population-based, random-digit-dialed telephone survey (n = 14,156). Primary measures were past NRT nonuse and future intentions regarding NRT use among current smokers intending to quit. Multiple logistic regression was used to identify reasons for past NRT nonuse associated with intention to use NRT in the future, adjusted for factors known to influence NRT use.

RESULTS

Nearly, 80% of 1,095 current smokers who intended to quit had never used NRT. The most common reasons for nonuse were belief that "willpower" alone is sufficient for cessation (21.5%), perceived lack of NRT effectiveness (15.6%), and cost (14.3%). Willpower was more widely reported among Hispanics than Anglos (36.9% vs. 14.7%) and nondaily versus daily smokers (30.4% vs. 12.5%). Most previous NRT nonusers reported they would use cold turkey (65.2%) in their next quit attempt; NRT was the next most common choice (15.0%). In multivariate analysis, smokers identifying cost or willpower as a reason for previous nonuse had significantly lower odds of planning to use NRT in a future quit attempt.

CONCLUSIONS

The majority of smokers have never used NRT and do not plan to use it in the future. Cost and belief in willpower alone are significant barriers to using NRT in future smoking cessation attempt.

Methods used to quit smoking by people with physical disabilities

PURPOSE/OBJECTIVE

People with mobility impairments (MIs) have higher smoking rates than the general population. We evaluated the use of psychosocial and pharmacological methods to quit smoking and readiness to quit smoking in this population in a cross-sectional study.

RESEARCH METHOD/DESIGN

Current and former smokers with MIs who needed equipment to ambulate (e.g., cane, wheelchair; n = 152, 53.3% female, 86.2% current smokers) were recruited from the community and interviewed by telephone regarding their lifetime use of various quit methods and readiness to quit smoking.

RESULTS

Results indicated that 57.3% reported a quit attempt in the past year, and 62% and 88.4% were planning on quitting in the next 30 days and six months, respectively. A minority of smokers with MIs reported using any type of counseling (5.3%; 3.3% in-person counseling and 2.6% phone counseling) or tablet medication (8.6%); 75% had made a "cold turkey" quit attempt (e.g., without any assistance). 36.8% and 19.7% reported using the nicotine patch and gum, respectively. Regression analyses indicated that greater nicotine dependence was associated with lower use of psychosocial treatments (p < .05), greater education was associated with greater tablet medication use (p = .051), and higher income was associated with both greater nicotine replacement therapy (NRT) and tablet medication use (p < .05). Minorities with MIs were significantly less likely to use NRT than non-Hispanic Whites (p < .05).

CONCLUSIONS

Individuals with MIs are motivated to quit smoking but underuse some empirically validated cessation treatment options.

School-based promotion of cessation support: reach of proactive mailings and acceptability of treatment in smoking parents recruited into cessation support through primary schools

Background

Several forms of cessation support have been shown effective in increasing the chance of successful smoking cessation, but cessation support is still underutilized among smokers. Proactive outreach to target audiences may increase use of cessation support.

Methods

The present study evaluated the efficiency of using study invitation letters distributed through primary schools in recruiting smoking parents into cessation support (quitline support or a self-help brochure). Use and evaluation of cessation support among smoking parents were examined.

Results

Findings indicate that recruitment of smokers into cessation support remains challenging. Once recruited, cessation support was well received by smoking parents. Of smokers allocated to quitline support, 88% accepted at least one counselling call. The average number of calls taken was high (5.7 out of 7 calls). Of smokers allocated to receive self-help material, 84% read at least some parts of the brochure. Of the intention-to-treat population, 81% and 69% were satisfied with quitline support or self-help material, respectively. Smoking parents were significantly more positive about quitline support compared to self-help material (p<.001).

Conclusions

Cessation support is well-received and well-used among smoking parents recruited through primary schools. Future studies need to examine factors that influence the response to offers of cessation support in samples of nonvolunteer smokers.

Trial registration

The protocol for this study is registered with the Netherlands Trial Register NTR2707

Young male daily smokers are nicotine dependent and experience several unsuccessful quit attempts

OBJECTIVE

Previous studies on smoking cessation have generally been conducted with adolescents or adults. Very little is known about the cessation attempts, their success, and/or use of pharmacological aids in young adult smokers who want to quit. The present study aimed to investigate quitting attempts in a group of both young male daily and occasional smokers.

DESIGN AND SUBJECTS

614 male smokers aged 18-26 years completed a standardized questionnaire about their smoking habits, quit attempts, and aids used in smoking cessation.

RESULTS

Nearly all daily smokers (95.3%, 95% CI 93.1-96.8) were nicotine addicted to some extend according to the standardized questionnaire, and the more addicted they were, the more often they had tried to quit (p = 0.025). Of the daily smokers, 55.6% (95% CI 51.3-59.9) had made quit attempts and 36.2% (95% CI 32.1-40.4) had used nicotine replacement therapy (NRT). In all, 34.1% (95% CI 25.2-44.3) of all occasional smokers reported having intended to quit but they had seldom made more than one attempt whereas 20.2% of daily smokers had made at least three attempts. The stronger the nicotine dependence in daily smokers was, the more likely the subject was to have attempted to use NRT (quite dependent 23.8% vs. totally dependent 48.9%) (p < 0.001).

CONCLUSIONS

A high proportion of young male daily smokers were nicotine addicted. Young smokers make many unsuccessful attempts to stop smoking using nicotine replacement therapy (NRT) on their own. A better availability of professional cessation services directed to young adult smokers is needed.

Identifying Barriers to Entering Smoking Cessation Treatment Among Socioeconomically Disadvantaged Smokers

Background:Efficacious smoking cessation interventions exist, yet few smokers utilise available resources such as psychosocial treatment programs and pharmacotherapy. The goals of the present study were to (1) identify perceived barriers to entering smoking cessation treatment programs among socioeconomically disadvantaged smokers, who are presently underrepresented in smoking cessation interventions; (2) determine what variables are most important in predicting the barriers identified (i.e., age, gender, ethnicity, income, nicotine dependence level, smoking rate, years smoking, stage of change, presence of smoking-related illness and medical insurance status).Methods:Responses from socioeconomically disadvantaged smokers (N= 343) were collected in 2004–2005 and analysed to develop the Treatment Barriers Questionnaire, a 40-item measure of reasons for not entering smoking cessation programs. Study methods were approved by the Institutional Review Board of Louisiana State University; informed consent procedures were employed.Results:Principal components analysis yielded seven scales named for their theme: (1) Preparedness to Quit Smoking; (2) Work and Time Constraints; (3) Smokers Can or Should Quit on Own; (4) Opinions about Professional Assistance; (5) Mobility Limitations; (6) Insurance Limitations and (7) Misinformation about Professional Assistance. Gender, ethnicity, daily smoking rate, nicotine dependence and stage of change were significant predictors in regression analyses for scales 1,F(10, 201) = 7.83,p< .001,R2= .29, 2F(10, 201) = 2.30,p< .05,R2= .11, and 3,F(10, 201) = 3.58,p< .001,R2= .16. Conclusions: Results can inform efforts to facilitate entry and retention of smokers in cessation programs.

Nicotine therapy sampling to induce quit attempts among smokers unmotivated to quit: a randomized clinical trial

BACKGROUND

Rates of smoking cessation have not changed in a decade, accentuating the need for novel approaches to prompt quit attempts.

METHODS

Within a nationwide randomized clinical trial (N = 849) to induce further quit attempts and cessation, smokers currently unmotivated to quit were randomized to a practice quit attempt (PQA) alone or to nicotine replacement therapy (hereafter referred to as nicotine therapy), sampling within the context of a PQA. Following a 6-week intervention period, participants were followed up for 6 months to assess outcomes. The PQA intervention was designed to increase motivation, confidence, and coping skills. The combination of a PQA plus nicotine therapy sampling added samples of nicotine lozenges to enhance attitudes toward pharmacotherapy and to promote the use of additional cessation resources. Primary outcomes included the incidence of any ever occurring self-defined quit attempt and 24-hour quit attempt. Secondary measures included 7-day point prevalence abstinence at any time during the study (ie, floating abstinence) and at the final follow-up assessment.

RESULTS

Compared with PQA intervention, nicotine therapy sampling was associated with a significantly higher incidence of any quit attempt (49% vs 40%; relative risk [RR], 1.2; 95% CI, 1.1-1.4) and any 24-hour quit attempt (43% vs 34%; 1.3; 1.1-1.5). Nicotine therapy sampling was marginally more likely to promote floating abstinence (19% vs 15%; RR, 1.3; 95% CI, 1.0-1.7); 6-month point prevalence abstinence rates were no different between groups (16% vs 14%; 1.2; 0.9-1.6).

CONCLUSION

Nicotine therapy sampling during a PQA represents a novel strategy to motivate smokers to make a quit attempt.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00706979.

Factors predicting the initiation of a tobacco cessation program in Spain

There have been limited studies regarding the characteristics of subjects who have decided to initiate a cessation program to quit tobacco smoking. Identifying such characteristics is important because it provides information regarding recruiting and tailoring strategies, as well as intervention methods. This observational trial with cross-sectional data analysis sought to identify the characteristics of subjects who have decided to initiate a smoking cessation program compared with those who did not. All subjects who asked for information about our cessation program between January 2000 and December 2005 were eligible for participation. All subjects were interviewed regarding their tobacco consumption practices. We also collected information on medical history and psychological conditions. Multivariate analysis was used to identify variables associated with the decision to initiate the cessation program. A total of 1,681 subjects asked for information about smoking cessation at our center, and 1,132 (67.3%) decided to enter our program. Independent factors associated with the decision to initiate the cessation program included female gender (OR: 1.54; 95% CI:1.23-1.93), having a university degree (OR: 1.46; 95% CI: 1.12-1.88), bronchial asthma (OR: 0.41; 95% CI: 0.24-0.71), nonpsychotic psychiatric disorders (OR: 0.52; 95% CI: 0.40-0.66), psychotic disorders (OR: 6.00; 95% CI: 2.74-13.14), and a history of insomnia (OR: 6.22; 95% CI: 1.85-20.87). Although all smokers should be counseled to quit smoking, our data may help to concentrate efforts on some subjects in order to increase the participation in smoking cessation programs.

Effectiveness of proactive telephone counselling for smoking cessation in parents: study protocol of a randomized controlled trial

Background

Smoking is the world's fourth most common risk factor for disease, the leading preventable cause of death, and it is associated with tremendous social costs. In the Netherlands, the smoking prevalence rate is high. A total of 27.7% of the population over age 15 years smokes. In addition to the direct advantages of smoking cessation for the smoker, parents who quit smoking may also decrease their children's risk of smoking initiation.

Methods/Design

A randomized controlled trial will be conducted to evaluate the effectiveness of proactive telephone counselling to increase smoking cessation rates among smoking parents. A total of 512 smoking parents will be proactively recruited through their children's primary schools and randomly assigned to either proactive telephone counselling or a control condition. Proactive telephone counselling will consist of up to seven counsellor-initiated telephone calls (based on cognitive-behavioural skill building and Motivational Interviewing), distributed over a period of three months. Three supplementary brochures will also be provided. In the control condition, parents will receive a standard brochure to aid smoking cessation. Assessments will take place at baseline, three months after start of the intervention (post-measurement), and twelve months after start of the intervention (follow-up measurement). Primary outcome measures will include sustained abstinence between post-measurement and follow-up measurement and 7-day point prevalence abstinence and 24-hours point prevalence abstinence at both post- and follow-up measurement. Several secondary outcome measures will also be included (e.g., smoking intensity, smoking policies at home). In addition, we will evaluate smoking-related cognitions (e.g., attitudes towards smoking, social norms, self-efficacy, intention to smoke) in 9-12 year old children of smoking parents.

Discussion

This study protocol describes the design of a randomized controlled trial to evaluate the effectiveness of proactive telephone counselling in smoking cessation. It is expected that, in the telephone counseling condition, parental smoking cessation rates will be higher and children's cognitions will be less favorable about smoking compared to the control condition.

Trial registration

The protocol for this study is registered with the Netherlands Trial Register NTR2707.

Rates and reasons: disparities in low intentions to use a state smoking cessation quitline

PURPOSE

Little is known about population-level rates and reasons for low intentions to call the quitline, a widely available evidence-based smoking cessation treatment.

DESIGN

This study is a secondary analysis of the 2008 Colorado Adult Tobacco Attitudes and Behavior Survey.

SETTING

This is a population-based telephone survey of adults in Colorado.

SUBJECTS

Study respondents (N = 1662) included current adult smokers who had heard of the Colorado QuitLine (QL) and did not report that they never intend to quit.

MEASURES

Outcome measures included intent to call the QL, self-reported reasons for not intending to call the QL, and knowledge of QL services.

ANALYSIS

Descriptive and multivariate logistic regression analyses were used for each outcome variable. All analyses were weighted for complex survey design to represent the population of Colorado.

RESULTS

Overall 45.6% of smokers intend never to call the QL. In multivariate analysis, Latinos (odds ratio [OR] = 2.5; 95% confidence intervals [CI], 1.4, 4.7), gay/lesbian/bisexuals (OR = 5.2; 95% CI, 2.4, 11.4), and those with no insurance compared with Medicaid (OR = 3.8; 95% CI, 1.1, 13.0) were most likely to intend never to call the QL. Perceiving no need for assistance (34.8%) was the most common reason for not calling.

CONCLUSIONS

A majority of smokers have no or weak intentions of ever calling the QL, with variation by subgroup. Reasons for not intending to call can inform targeted media campaigns to increase QL reach.

Increasing consumer demand for tobacco treatments: Ten design recommendations for clinicians and healthcare systems

Health professionals play an important role in addressing patient tobacco use in clinical settings. While there is clear evidence that identifying tobacco use and assisting smokers in quitting affects outcomes, challenges to improve routine, clinician-delivered tobacco intervention persist. The Consumer Demand Initiative has identified simple design principles to increase consumers' use of proven tobacco treatments. Applying these design strategies to activities across the healthcare system, we articulate ten recommendations that can be implemented in the context of most clinical systems where most clinicians work. The recommendations are: (1) reframe the definition of success, (2) portray proven treatments as the best care, (3) redesign the 5A's of tobacco intervention, (4) be ready to deliver the right treatment at the right time, (5) move tobacco from the social history to the problem list, (6) use words as therapy and language that makes sense, (7) fit tobacco treatment into clinical team workflows, (8) embed tobacco treatment into health information technology, (9) make every encounter an opportunity to intervene, and (10) end social disparities for tobacco users. Clinical systems need to change to improve tobacco treatment implementation. The consumer- and clinician-centered recommendations provide a roadmap that focuses on increasing clinician performance through greater understanding of the clinician's role in helping tobacco users, highlighting the value of evidence-based tobacco treatments, employing shared decision-making skills, and integrating routine tobacco treatment into clinical system routines.

Comparison of cannabis and tobacco withdrawal: severity and contribution to relapse

This naturalistic telephone survey study compared perceptions of withdrawal severity in 67 daily cannabis users and 54 daily tobacco cigarette smokers who made quit attempts during the prior 30 days. A Withdrawal Symptom Checklist assessed the severity of abstinence symptoms and a Likert scale assessed perceived relations between abstinence symptoms and relapse. A composite Withdrawal Discomfort Score did not differ significantly between groups (M = 13.0 for cannabis, vs. M = 13.2 for tobacco). Individual symptom severity ratings were also of similar magnitude, except craving and sweating were slightly higher for tobacco. Both groups reported that withdrawal contributed substantially to relapse, and the strength of these ratings was similar across groups. The diverse convenience sample examined in this study adds external validity and generalizability to prior studies that included only users not planning to quit or excluded many common types of cannabis users. The comparable withdrawal experience from these heterogeneous cannabis and tobacco users supports previous findings from controlled laboratory studies and indicates that real-world, frequent cannabis users perceive that withdrawal symptoms negatively affect their desire and ability to quit.