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van Westen-Lagerweij NA, Bommelé J, Willemsen MC, Croes EA. Mentioning smoking cessation assistance during healthcare consultations matters: findings from Dutch survey research. Eur J Public Health 2022; 32:747-752. [PMID: 36001051 PMCID: PMC9527971 DOI: 10.1093/eurpub/ckac106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Smoking cessation assistance (SCA) can help smokers to successfully quit smoking. It is unclear to what extent hearing about SCA from a healthcare professional is associated with using SCA during a quit attempt. Methods We used pooled survey data from the 2016, 2018 and 2020 ‘Module Substance Use’ survey in the Netherlands (N = 5928). Multivariate logistic regression analyses were used to determine the association between having heard about SCA from one or more healthcare professionals in the last year and the use of SCA during the most recent quit attempt in the last year. We used two models: model 1 included any type of assistance; model 2 included assistance typically recommended by treatment guidelines (i.e. counselling and pharmacotherapy). Results Hearing about any type of SCA from a healthcare professional in the last year was significantly associated with using any type of SCA during the most recent quit attempt [odds ratio (OR) = 2.96; 95% confidence interval (CI) 2.16–4.06; P < 0.001]. We found the strongest association between hearing about counselling and/or pharmacotherapy and using counselling and/or pharmacotherapy (OR = 5.40; 95% CI 4.11–11.60; P < 0.001). The odds of using SCA was not significantly higher for smokers who had heard about it from two or more healthcare professionals compared to one healthcare professional (OR = 1.38; 95% CI 0.79–2.42; P = 0.26). Conclusions Healthcare professionals can play a greater role in stimulating the use of SCA, especially counselling and pharmacotherapy, by mentioning it to smokers during consultations.
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Affiliation(s)
- Naomi A van Westen-Lagerweij
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands.,Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Jeroen Bommelé
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
| | - Marc C Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands.,Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Esther A Croes
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, Utrecht, The Netherlands
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2
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van Westen-Lagerweij NA, Meeuwsen EG, Croes EA, Meijer E, Chavannes NH, Willemsen MC. The referral of patients to smoking cessation counselling: perceptions and experiences of healthcare providers in general practice. BMC Health Serv Res 2021; 21:583. [PMID: 34140004 PMCID: PMC8210508 DOI: 10.1186/s12913-021-06618-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Few European smokers receive professional counselling when attempting to quit smoking, resulting in suboptimal success rates and poor health outcomes. Healthcare providers in general practice play an important role in referring smokers to smoking cessation counselling. We chose the Netherlands as a case study to qualitatively explore which factors play a role among healthcare providers in general practice with regard to referral for smoking cessation counselling organised both inside and outside general practice. Methods We conducted four focus groups and 18 telephone interviews, with a total of 31 healthcare providers who work in general practice. Qualitative content analysis was used to identify relevant factors related to referral behaviours, and each factor was linked to one of the three main components of the COM-B behaviour model (i.e., capability, opportunity and motivation) as well as the six sub-components of the model. Results Dutch healthcare providers in general practice typically refer smokers who want to quit to counselling inside their own general practice without actively discussing other counselling options, indicating a lack of shared decision making. The analysis showed that factors linked to the COM-B main components ‘capability’ and ‘opportunity’, such as healthcare providers’ skills and patients’ preferences, play a role in whether patients are referred to counselling inside general practice. Factors linked to all three COM-B components were found to play a role in referrals to counselling outside general practice. These included (knowledge of) the availability and quality of counselling in the region, patients’ requests, reimbursement, and sense of urgency to refer. The identified factors can both act as barriers and facilitators. Conclusions The findings of this research suggest that more smokers can be reached with smoking cessation counselling if implementation interventions focus on: (i) equipping healthcare providers with the knowledge and skills needed to refer patients; (ii) creating more opportunities for healthcare providers to refer patients (e.g., by improving the availability and reimbursement of counselling options); and (iii) motivating healthcare providers to discuss different counselling options with patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06618-7.
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Affiliation(s)
- Naomi A van Westen-Lagerweij
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands. .,Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Elisabeth G Meeuwsen
- Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Esther A Croes
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands
| | - Eline Meijer
- Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Marc C Willemsen
- The Netherlands Expertise Centre for Tobacco Control, Trimbos Institute, PO Box 725, 3500 AS, Utrecht, The Netherlands.,Department of Health Promotion, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
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3
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Finocchio E, Olivieri M, Nguyen G, Bortolami O, Marchetti P, Vesentini R, Torroni L, Spiteri G, Locatelli F, Moretti F, Fois A, Pirina P, Ferrari M, Verlato G. Effects of Respiratory Disorders on Smoking Cessation and Re-Initiation in an Italian Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030903. [PMID: 33494306 PMCID: PMC7908144 DOI: 10.3390/ijerph18030903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022]
Abstract
The present study aims to prospectively assess the influence of respiratory disorders on smoking cessation and re-initiation. Three population-based Italian cohorts answered a questionnaire on respiratory health and smoking habits during 1998–2001 and after a mean follow-up (SD) of 9.1 (0.8) years. Out of 1874 current smokers and 1166 ex-smokers at baseline, 965 (51.5%) and 735 (63.0%) reported their smoking status at follow-up. From current smokers, 312 had stopped smoking at follow-up, while 86 ex-smokers had resumed smoking. People reporting asthma at baseline were more likely to stop smoking than the other subjects (48.6% vs. 31.7%), while people reporting allergic rhinitis or chronic cough/phlegm had a higher probability to resume smoking (16.7% vs. 10.5% and 20.7% vs. 10.4%, respectively). In the multivariable logistic model, smoking relapse strongly decreased with increasing abstinence duration in people without chronic cough/phlegm (OR for ≥7.5 years vs. <7.5 years = 0.23, 95% CI 0.20–0.27), while no effect was detected in people with chronic cough/phlegm (p for interaction = 0.039). Smoking cessation was enhanced in asthmatic subjects, while people with allergic rhinitis or chronic cough/phlegm were at higher risk to resume smoking. Chronic cough/phlegm blunted the decrease in smoking resumption associated with longer abstinence duration.
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Affiliation(s)
- Eliana Finocchio
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Mario Olivieri
- Unit of Occupational Medicine, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy;
- Correspondence: ; Tel.: +39-045-8124921
| | - Giang Nguyen
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Oscar Bortolami
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Pierpaolo Marchetti
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Roberta Vesentini
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Lorena Torroni
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Gianluca Spiteri
- Unit of Occupational Medicine, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy;
| | - Francesca Locatelli
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
| | - Francesca Moretti
- Unit of Hygiene, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy;
| | - Alessandro Fois
- Unit of Lung Disease, Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (A.F.); (P.P.)
| | - Pietro Pirina
- Unit of Lung Disease, Department of Clinical and Experimental Medicine, University of Sassari, 07100 Sassari, Italy; (A.F.); (P.P.)
| | - Marcello Ferrari
- Unit of Respiratory Diseases, Department of Medicine, University of Verona, 37134 Verona, Italy;
| | - Giuseppe Verlato
- Unit of Epidemiology & Medical Statistics, Department of Diagnostics & Public Health, University of Verona, 37134 Verona, Italy; (E.F.); (G.N.); (O.B.); (P.M.); (R.V.); (L.T.); (F.L.); (G.V.)
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Girvalaki C, Filippidis FT, Kyriakos CN, Driezen P, Herbeć A, Mons U, Papadakis S, Mechili EA, Katsaounou PA, Przewoźniak K, Fernández E, Trofor AC, Demjén T, Fong GT, Vardavas CI. Perceptions, Predictors of and Motivation for Quitting among Smokers from Six European Countries from 2016 to 2018: Findings from EUREST-PLUS ITC Europe Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6263. [PMID: 32872132 PMCID: PMC7504326 DOI: 10.3390/ijerph17176263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/23/2022]
Abstract
The European Tobacco Products Directive (TPD) was introduced in 2016 in an effort to decrease prevalence of smoking and increase cessation in the European Union (EU). This study aimed to explore quitting behaviours, motivation, reasons and perceptions about quitting, as well as predictors (reported before the TPD implementation) associated with post-TPD quit status. A cohort study was conducted involving adult smokers from six EU countries (n = 3195). Data collection occurred pre-(Wave 1; 2016) and post-(Wave 2; 2018) TPD implementation. Bivariate and logistic regression analyses of weighted data were conducted. Within this cohort sample, 415 (13.0%) respondents reported quitting at Wave 2. Predictors of quitting were moderate or high education, fewer cigarettes smoked per day at baseline, a past quit attempt, lower level of perceived addiction, plans for quitting and the presence of a smoking-related comorbidity. Health concerns, price of cigarettes and being a good example for children were among the most important reasons that predicted being a quitter at Wave 2. Our findings show that the factors influencing decisions about quitting may be shared among European countries. European policy and the revised version of TPD could emphasise these factors through health warnings and/or campaigns and other policies.
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Affiliation(s)
- Charis Girvalaki
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- European Network for Smoking and Tobacco Prevention, 1050 Brussels, Belgium
| | - Filippos T. Filippidis
- Department of Primary Care and Public Health, Imperial College, London W6 8RP, UK;
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, 10561 Athens, Greece;
| | - Christina N. Kyriakos
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- European Network for Smoking and Tobacco Prevention, 1050 Brussels, Belgium
| | - Pete Driezen
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Aleksandra Herbeć
- Health Promotion Foundation, 00 764 Warsaw, Poland; (A.H.); (K.P.); (G.T.F.)
- Centre for Behaviour Change, Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
- Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany
| | - Sophia Papadakis
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, and Faculty of Medicine, University of Ottawa, Ottawa, ON K1Y 4W7, Canada
| | - Enkeleint A. Mechili
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- European Network for Smoking and Tobacco Prevention, 1050 Brussels, Belgium
- Department of Health Care, Faculty of Public Health, University of Vlora, 9401 Vlora, Albania
| | - Paraskevi A. Katsaounou
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, 10561 Athens, Greece;
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, 00 764 Warsaw, Poland; (A.H.); (K.P.); (G.T.F.)
- Maria Skłodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- Collegium Civitas, 00-901 Warsaw, Poland
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), 08908 L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain;
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), 08908 L’Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, 08908 L’Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), 28029 Madrid, Spain
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, 700115 Iasi, Romania;
- Aer Pur Romania, 052034 Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, 1044 Budapest, Hungary;
| | - Geoffrey T. Fong
- Health Promotion Foundation, 00 764 Warsaw, Poland; (A.H.); (K.P.); (G.T.F.)
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
| | - Constantine I. Vardavas
- Medical School, University of Crete, Heraklion, 71003 Crete, Greece; (C.N.K.); (S.P.); (E.A.M.); (C.I.V.)
- European Network for Smoking and Tobacco Prevention, 1050 Brussels, Belgium
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Towards a Tobacco Free Ireland—scaling up and strengthening quit smoking behaviour at population level. Ir J Med Sci 2020; 189:3-10. [DOI: 10.1007/s11845-019-02083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
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Cheung CMM, Vardavas CI, Filippidis FT. Factors associated with abstinence after a recent smoking cessation attempt across 28 European Union member states. Tob Prev Cessat 2020; 7:5. [PMID: 33511319 PMCID: PMC7831377 DOI: 10.18332/tpc/132123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION There is a lack of information regarding factors associated with successful smoking cessation on a population and European Union (EU)-wide level. Our study seeks to explore individual and country-level factors associated with abstinence after a recent smoking cessation attempt across the EU. METHODS We obtained data from the March 2017 Special Eurobarometer 87.1 (n=27901). Regression analysis was performed on a subset of 1472 individuals who made quit attempts in the past 12 months. Sociodemographic, policy and country-level factors were assessed using logistic regression among smokers and ex-smokers who attempted to quit approximately 12 months before the survey date. We defined and examined the Cessation Ratio (ratio of number of recent quitters to those who did not succeed) across 28 EU Member States. RESULTS In all, 14.9% (n=1018) of current smokers and 8.80% (n=454) of ex-smokers attempted to quit in approximately the last 12 months (n=1472). Cessation Ratios ranged from 0.182 (95% CI: 0.045–0.319) in Estonia to 1.060 (95% CI: 0.262–1.860) in Sweden. There is a quadratic, U-shaped relationship between odds of quitting and smoking prevalence. The lowest odds of cessation were observed at a prevalence of 26.3%, with higher odds of cessation observed above and below this point. Respondents who reported financial difficulties were less likely to quit (AOR=0.66; 95% CI: 0.52–0.83). There was no association of likelihood of success with other sociodemographic factors or the Tobacco Control Scale treatment score. CONCLUSIONS These findings highlight a need for exploring reasons behind the variation in likelihood of abstinence following a recent quit attempt, in order to design policies targeted at population groups or countries that need greater support.
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Affiliation(s)
- Chung-Mei M Cheung
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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7
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Fujita T, Babazono A, Harano Y, Jiang P. Influence of Occupational Background on Smoking Prevalence as a Health Inequality Among Employees of Medium- and Small-Sized Companies in Japan. Popul Health Manag 2019; 23:183-193. [PMID: 31207197 PMCID: PMC7074897 DOI: 10.1089/pop.2019.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tobacco smoking is a major public health problem. In addition, the influence of socioeconomic status on health inequalities has received great attention worldwide. The authors used insurance data of beneficiaries employed in medium- and small-sized Japanese companies to investigate the influence of occupational background on smoking prevalence as a health inequality among workers in Japan. Participants were aged 35–74 years and underwent health examinations in 2015. Smoking prevalence was estimated for each occupational group according to sex, age, and income. Logistic regression analysis was used to assess the association between smoking status and occupational groups. A total of 385,945 participants were included. Overall smoking prevalence was 36.3%, higher than average in Japan. Smoking prevalence was lowest among workers in the education and learning support category; all other occupational groups had significantly high prevalence, with the highest for transport and postal services (odds ratio 2.69, 95% confidence interval 2.53–2.86). There were few differences in smoking prevalence at higher income levels among female participants, but differences were remarkably significant at lower income levels. For health inequalities related to smoking, occupational background was associated with smoking prevalence. In particular, there was high smoking prevalence in workplaces not covered by smoke-free policies. These results also demonstrated differences between the sexes; smoking prevalence among female workers with lower income levels was strongly associated with occupational background whereas there were no large differences among male workers by income. These findings suggest that the government should encourage companies to adopt smoke-free policies in the workplace.
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Affiliation(s)
- Takako Fujita
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.,Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Healthcare Administration and Management, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yumi Harano
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Peng Jiang
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Fujita T, Babazono A, Harano Y, Jiang P. Risk of depressive disorders after tobacco smoking cessation: a retrospective cohort study in Fukuoka, Japan. BMJ Open 2019; 9:e025124. [PMID: 30904860 PMCID: PMC6475226 DOI: 10.1136/bmjopen-2018-025124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE We sought to examine the effect of smoking cessation on subsequent development of depressive disorders. DESIGN This was a retrospective cohort study. METHODS We used administrative claim and health check data from fiscal years 2010 to 2014, obtained from the largest health insurance association in Fukuoka, Japan. Study participants were between 30 and 69 years old. The end-point outcome was incidence of depressive disorders. Survival analysis and Cox proportional hazards models were conducted. The evaluated potential confounders were sex, age, standard monthly income and psychiatric medical history. RESULTS The final number of participants was 87 255, with 7841 in the smoking cessation group and 79 414 in the smoking group. The result of survival analysis showed no significant difference in depressive disorders between the two groups. The results of Cox proportional hazards models showed no significant difference by multivariate analysis between participants, including users of smoking cessation medication (HR 1.04, 95% Cl 0.89 to 1.22) and excluding medication use (HR 0.97, 95% Cl 0.82 to 1.15). CONCLUSIONS The present study showed that there were no significant differences with respect to having depressive disorders between smoking cessation and smoking groups. We also showed that smoking cessation was not related to incidence of depressive disorders among participants, including and excluding users of smoking cessation medication, after adjusting for potential confounders. Although the results have some limitations because of the nature of the study design, our findings will provide helpful information to smokers, health professionals and policy makers for improving smoking cessation.
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Affiliation(s)
- Takako Fujita
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Healthcare Administration and Management, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yumi Harano
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Peng Jiang
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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9
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Doran N, Dubrava S, Anthenelli RM. Effects of Varenicline, Depressive Symptoms, and Region of Enrollment on Smoking Cessation in Depressed Smokers. Nicotine Tob Res 2019; 21:156-162. [PMID: 29471329 PMCID: PMC6329403 DOI: 10.1093/ntr/nty033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/14/2018] [Indexed: 11/12/2022]
Abstract
Introduction Despite effective treatments, relapse to smoking remains a vexing global health problem. One predictor of relapse is depressive symptoms. Medications such as varenicline reduce withdrawal-related symptoms of depression, reducing relapse. This study examined whether varenicline moderated the effect of depressive symptoms on relapse, and whether this varied by region of enrollment. Methods Adult smokers (n = 525; 37% male) with past or current, stable major depressive disorder recruited from United States (n = 255), and European (n = 270) sites participated in a randomized, double-blind cessation treatment trial including 12 weeks of varenicline or placebo, with 40-week nontreatment follow-up. Results Longitudinal and binary logistic regressions were used to model the probability of sustained abstinence by end of treatment and point-prevalence abstinence in follow-up. The association between depression symptoms and abstinence was moderated by intervention group at end of treatment, and by region during follow-up: more severe symptoms were associated with end-of-treatment relapse for placebo (odds ratio [OR] = 0.91, p = .003), but not varenicline (OR = 0.99, p = .568). During follow-up, increased symptoms of depression predicted greater likelihood of smoking for European (p = .009) but not US participants. Europeans were more likely to be abstinent for both outcomes (p < .01). Conclusions These results extend studies demonstrating varenicline is associated with less withdrawal-related depression, and suggest it aids cessation even in smokers with depressive symptoms. Findings also suggest regional differences in the relationship between depressive symptoms and cessation that may be related to differences in prevalence. Implications This study indicates varenicline may aid cessation partially by reducing withdrawal-related symptoms of depression. It also suggests that the impact of depressive symptoms on cessation varies regionally, and that this variation may be related to differences in smoking prevalence.
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Affiliation(s)
- Neal Doran
- Department of Psychiatry, Health Sciences, University of California, San Diego
- Mental Health Care Line, Veterans Affairs San Diego Healthcare System
| | | | - Robert M Anthenelli
- Department of Psychiatry, Health Sciences, University of California, San Diego
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10
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Filippidis FT, Laverty AA, Mons U, Jimenez-Ruiz C, Vardavas CI. Changes in smoking cessation assistance in the European Union between 2012 and 2017: pharmacotherapy versus counselling versus e-cigarettes. Tob Control 2019; 28:95-100. [PMID: 29563220 PMCID: PMC6317445 DOI: 10.1136/tobaccocontrol-2017-054117] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/25/2018] [Accepted: 02/26/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND The landscape of smoking cessation may have changed in Europe recently. OBJECTIVES To identify changes in use of smoking cessation assistance in the European Union (EU) and factors associated with use of cessation assistance. METHODS Data from the 2012 (n=9921) and 2017 (n=9489) waves of the Eurobarometer survey were used. Self-reported use of smoking cessation assistance was assessed among smokers who had ever tried to quit and former smokers. Changes in use of each type of assistance were assessed using logistic regression. RESULTS Among current and former smokers, those who had ever attempted to quit without assistance increased from 70.3% (2012) to 74.8% (2017). Current smokers were more likely to have used any assistance compared with former smokers (P<0.001). Use of e-cigarettes for smoking cessation assistance increased (3.7% to 9.7%)%), while use of pharmacotherapy (14.6% to 11.1%)%) and smoking cessation services (7.5% to 5.0%)%) declined. Younger people were more likely to have reported e-cigarette use for smoking cessation but less likely to have used a cessation service. Individuals living in countries with comprehensive smoking cessation policies were more likely to have used any cessation assistance (adjusted OR (aOR)=1.78; 95% CI 1.15 to 2.76), pharmacotherapy (aOR=3.44; 95% CI 1.78 to 6.66) and smoking cessation services (aOR=2.27; 95% CI 1.27 to 4.06) compared with those living in countries with weak smoking cessation policies. CONCLUSIONS These findings highlight the need for approaches that ensure that smokers get support to quit smoking across the EU. The question of whether the availability of e-cigarettes will displace other methods, and the impact of such a displacement, should be closely evaluated.
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Affiliation(s)
- Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center, Heidelberg, Germany
| | | | - Constantine I Vardavas
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Institute of Public Health, American College of Greece, Athens, Greece
- Nicotine Dependence Center, Mayo Clinic, Rochester, Minnesota, USA
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Hummel K, Nagelhout GE, Fong GT, Vardavas CI, Papadakis S, Herbeć A, Mons U, van den Putte B, Borland R, Fernández E, de Vries H, McNeill A, Gravely S, Przewoźniak K, Kovacs P, Trofor AC, Willemsen MC. Quitting activity and use of cessation assistance reported by smokers in eight European countries: Findings from the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2018; 16:A6. [PMID: 31363422 PMCID: PMC6659556 DOI: 10.18332/tid/98912] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION There is clear evidence that the use of cessation aids significantly increases the likelihood of successful smoking cessation. The aim of this study was to examine quitting activity and use of cessation aids among smokers from various European countries. Subgroup differences were also examined for sex, income, education, and age in each country. METHODS Cross-sectional data were collected in 2016 from 10,683 smokers in eight European countries participating in the ITC Project: England (n=3,536), Germany (n=1,003), Greece (n=1,000), Hungary (n=1,000), the Netherlands (n=1,136), Poland (n=1,006), Romania (n=1,001), and Spain (n=1,001). We measured quitting activity, including quit attempts in the previous 12 months and intention to quit, use of cessation aids (i.e., medication, quitlines, internet, local services, and e-cigarettes), and whether respondents had received advice about quitting and e-cigarettes from health professionals. RESULTS Quit attempts were most common in England (46.3%) and least common in Hungary (10.4%). Quit intention was highest in England and lowest in Greece. Use of e-cigarettes to quit was highest in England (51.6%) and lowest in Spain (5.0%). Use of cessation aids was generally low across all countries; in particular this was true for quitlines, internet-based support, and local services. Receiving health professional advice to quit was highest in Romania (56.5%), and lowest in Poland (20.8%); few smokers received advice about e-cigarettes from health professionals. No clear differences were found for sex and income groups. Across countries, smokers with lower education reported less quitting activity. CONCLUSIONS Quitting activity and use of cessation methods were low in most countries. Greater quit attempts and use of cessation aids were found in England, where large investments in tobacco control and smoking cessation have been made. Health professionals are important for motivating smokers to quit and promoting the effectiveness of various methods, but overall, few smokers get advice to quit.
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Affiliation(s)
- Karin Hummel
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Gera E. Nagelhout
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
- IVO Research Institute, The Hague, the Netherlands
| | - Geoffrey T. Fong
- Department of Psychology & School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Constantine I. Vardavas
- University of Crete (UoC), Heraklion, Greece
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Sophia Papadakis
- University of Crete (UoC), Heraklion, Greece
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Aleksandra Herbeć
- Health Promotion Foundation, Warsaw, Poland
- UK Centre for Tobacco and Alcohol Studies, London, United Kingdom
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Ute Mons
- Cancer Prevention Unit & WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Bas van den Putte
- Department of Communication, University of Amsterdam (ASCoR), Amsterdam, the Netherlands
- Netherlands Expertise Center for Tobacco Control, Trimbos Institute, Utrecht, the Netherlands
| | - Ron Borland
- Cancer Council Victoria, Melbourne, Australia
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), and Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet, Catalonia, Spain
- School of Medicine and Health Sciences, University of Barcelona, Catalonia, Spain
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, London, United Kingdom
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Shannon Gravely
- Department of Psychology & School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Piroska Kovacs
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Marc C. Willemsen
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
- Netherlands Expertise Center for Tobacco Control, Trimbos Institute, Utrecht, the Netherlands
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Filippidis FT, Laverty AA, Vardavas CI. Experimentation with e-cigarettes as a smoking cessation aid: a cross-sectional study in 28 European Union member states. BMJ Open 2016; 6:e012084. [PMID: 27855092 PMCID: PMC5073471 DOI: 10.1136/bmjopen-2016-012084] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe patterns of experimentation with electronic cigarettes as a smoking cessation aid, their self-reported impact on smoking cessation and to identify factors associated with self-reported successful quit attempts within the European Union (EU). DESIGN A cross-sectional study. SETTING 28 European Union member states. METHODS We analysed data from wave 82.4 of the Special Eurobarometer survey, collected in December 2014 from all 28 EU member states. The total sample size was n=27 801 individuals aged ≥15 years; however, our analyses were conducted in different subgroups with sample sizes ranging from n=470 to n=9363. Data on e-cigarette experimentation and its self-reported impact on smoking cessation were collected. Logistic regression models were used to assess factors associated with experimentation of e-cigarettes as cessation aids and with successful quitting. Logistic regression was also used to assess changes in the use of e-cigarettes as cessation aids between 2012 (using data from wave 77.1 of the Eurobarometer) and 2014 in each member state. RESULTS E-cigarettes were often experimented with as a cessation aid, especially among younger smokers (OR=5.29) and those who reported financial difficulties (OR=1.33). In total, 10.6% of those who had ever attempted to quit smoking and 27.4% of those who did so using a cessation aid had experimented with e-cigarettes as a cessation aid. Among those who had used e-cigarettes as a cessation aid, those with higher education were more likely to have been successful in quitting (OR=2.23). There was great variation in trends of use of e-cigarette as a cessation aid between member states. CONCLUSIONS Experimentation with e-cigarettes as a potential cessation aid at a population level has increased throughout the EU in recent years, and certain population groups are more likely to experiment with them as cessation aids. Research on the potential population impact of these trends is imperatively needed.
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Affiliation(s)
- Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Constantine I Vardavas
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Beard E, Shahab L, Cummings DM, Michie S, West R. New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline? CNS Drugs 2016; 30:951-83. [PMID: 27421270 DOI: 10.1007/s40263-016-0362-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A wide range of support is available to help smokers to quit and to aid attempts at harm reduction, including three first-line smoking cessation medications: nicotine replacement therapy, varenicline and bupropion. Despite the efficacy of these, there is a continual need to diversify the range of medications so that the needs of tobacco users are met. This paper compares the first-line smoking cessation medications with (1) two variants of these existing products: new galenic formulations of varenicline and novel nicotine delivery devices; and (2) 24 alternative products: cytisine (novel outside Central and Eastern Europe), nortriptyline, other tricyclic antidepressants, electronic cigarettes, clonidine (an anxiolytic), other anxiolytics (e.g. buspirone), selective serotonin reuptake inhibitors, supplements (e.g. St John's wort), silver acetate, Nicobrevin, modafinil, venlafaxine, monoamine oxidase inhibitors (MAOIs), opioid antagonists, nicotinic acetylcholine receptor (nAChR) antagonists, glucose tablets, selective cannabinoid type 1 receptor antagonists, nicotine vaccines, drugs that affect gamma-aminobutyric acid (GABA) transmission, drugs that affect N-methyl-D-aspartate (NMDA) receptors, dopamine agonists (e.g. levodopa), pioglitazone (Actos; OMS405), noradrenaline reuptake inhibitors and the weight management drug lorcaserin. Six 'ESCUSE' criteria-relative efficacy, relative safety, relative cost, relative use (overall impact of effective medication use), relative scope (ability to serve new groups of patients) and relative ease of use-are used. Many of these products are in the early stages of clinical trials; however, cytisine looks most promising in having established efficacy and safety with low cost. Electronic cigarettes have become very popular, appear to be efficacious and are safer than smoking, but issues of continued dependence and possible harms need to be considered.
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Affiliation(s)
- Emma Beard
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK.
- Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 6BP, UK.
| | - Lion Shahab
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK
| | - Damian M Cummings
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 6BP, UK
| | - Robert West
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK
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Filippidis FT, Laverty AA, Gerovasili V, Vardavas CI. Two-year trends and predictors of e-cigarette use in 27 European Union member states. Tob Control 2016; 26:98-104. [PMID: 27220621 PMCID: PMC5256312 DOI: 10.1136/tobaccocontrol-2015-052771] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study assessed changes in levels of ever use, perceptions of harm from e-cigarettes and sociodemographic correlates of use among European Union (EU) adults during 2012-2014, as well as determinants of current use in 2014. METHODS We analysed data from the 2012 (n=26 751) and 2014 (n=26 792) waves of the adult Special Eurobarometer for Tobacco survey. Point prevalence of current and ever use was calculated and logistic regression assessed correlates of current use and changes in ever use, and perception of harm. Correlates examined included age, gender, tobacco smoking, education, area of residence, difficulties in paying bills and reasons for trying an e-cigarette. RESULTS The prevalence of ever use of e-cigarettes increased from 7.2% in 2012 to 11.6% in 2014 (adjusted OR (aOR)=1.91). EU-wide coefficient of variation in ever e-cigarette use was 42.1% in 2012 and 33.4% in 2014. The perception that e-cigarettes are harmful increased from 27.1% in 2012 to 51.6% in 2014 (aOR=2.99), but there were major differences in prevalence and trends between member states. Among those who reported that they had ever tried an e-cigarette in the 2014 survey, 15.3% defined themselves as current users. Those who tried an e-cigarette to quit smoking were more likely to be current users (aOR=2.82). CONCLUSIONS Ever use of e-cigarettes increased during 2012-2014. People who started using e-cigarettes to quit smoking tobacco were more likely to be current users, but the trends vary by country. These findings underscore the need for more research into factors influencing e-cigarette use and its potential benefits and harms.
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Affiliation(s)
- Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Vasiliki Gerovasili
- Department of Ergospirometry and Rehabilitation, Medical School, University of Athens, Athens, Greece
| | - Constantine I Vardavas
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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