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Meng Y, Xiang S, Qu L, Li Y. The efficacy and acceptability of pharmacological monotherapies and e-cigarette on smoking cessation: a systemic review and network meta-analysis. Front Public Health 2024; 12:1361186. [PMID: 38841681 PMCID: PMC11150810 DOI: 10.3389/fpubh.2024.1361186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 05/03/2024] [Indexed: 06/07/2024] Open
Abstract
Background and aims Several pharmacological interventions, such as nicotine replacement therapy (NRT), varenicline, and bupropion, have been approved for clinical use of smoking cessation. E-cigarettes (EC) are increasingly explored by many RCTs for their potentiality in smoking cessation. In addition, some RCTs are attempting to explore new drugs for smoking cessation, such as cytisine. This network meta-analysis (NMA) aims to investigate how these drugs and e-cigarettes compare regarding their efficacy and acceptability. Materials and methods This systematic review and NMA searched all clinical studies on smoking cessation using pharmacological monotherapies or e-cigarettes published from January 2011 to May 2022 using MEDLINE, COCHRANE Library, and PsychINFO databases. NRTs were divided into transdermal (TDN) and oronasal nicotine (ONN) by administrative routes, thus 7 network nodes were set up for direct and indirect comparison. Two different indicators measured the efficacy: prevalent and continuous smoking abstinence. The drop-out rates measured the acceptability. Results The final 40 clinical studies included in this study comprised 77 study cohorts and 25,889 participants. Varenicline is more effective intervention to assist in smoking cessation during 16-32 weeks follow-up, and is very likely to prompt dropout. Cytisine shows more effectiveness in continuous smoking cessation but may also lead to dropout. E-cigarettes and oronasal nicotine are more effective than no treatment in encouraging prevalent abstinence, but least likely to prompt dropout. Finally, transdermal nicotine delivery is more effective than no treatment in continuous abstinence, with neither significant effect on prevalent abstinence nor dropout rate. Conclusion This review suggested and agreed that Varenicline, Cytisine and transdermal nicotine delivery, as smoking cessation intervention, have advantages and disadvantages. However, we had to have reservations about e-cigarettes as a way to quit smoking in adolescents.
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Affiliation(s)
- Yajing Meng
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Sike Xiang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Lang Qu
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD, United States
| | - Ying Li
- Department of Cardiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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2
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Blondé J, Desrichard O, Falomir-Pichastor JM, Felder M, Folly L, Riedo G. Cohabitation with a smoker and efficacy of cessation programmes: the mediating role of the theory of planned behaviour. Psychol Health 2023; 38:1665-1682. [PMID: 35275033 DOI: 10.1080/08870446.2022.2041638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/31/2021] [Accepted: 02/09/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The present research sought to examine whether cohabitation with a smoker undermines smoking cessation among people engaged in a cessation programme and whether the components of the Theory of Planned Behaviour (TPB) act as mediating mechanisms. DESIGN A prospective longitudinal study with online questionnaires was conducted among smokers living in Switzerland who enrolled in a 6-months smoking cessation programme. MAIN OUTCOME MEASURES Cohabitation with a smoker and the TPB constructs were assessed 10 days after the start of the programme (T1; N = 820). Smoking abstinence was measured at T1, and at 3-months (T2; N = 624) and 6-months follow-ups (T3; N = 354). RESULTS Results showed that living with a smoker decreased the odds that smokers remained abstinent throughout the cessation programme. Furthermore, we found that cohabitation was negatively associated with subjective norm. Afterwards, subjective norm predicted intention to maintain smoking cessation, which, in turn, predicted smoking abstinence. Such mediation effects persisted at each time point. CONCLUSION The present research provided evidence that living with other smokers at home can lead to greater risks of relapsing among people engaged in a cessation programme. We discussed the role of smoking-related norms in the efficacy of cessation interventions. Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2022.2041638 .
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Affiliation(s)
- Jérôme Blondé
- Faculty of Psychology and Education Sciences, University of Geneva, Geneve, Switzerland
| | - Olivier Desrichard
- Faculty of Psychology and Education Sciences, University of Geneva, Geneve, Switzerland
| | | | - Max Felder
- Behaviour Change Lab, Geneve, Switzerland
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3
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Malbos E, Borwell B, Einig-Iscain M, Korchia T, Cantalupi R, Boyer L, Lancon C. Virtual reality cue exposure therapy for tobacco relapse prevention: a comparative study with standard intervention. Psychol Med 2023; 53:5070-5080. [PMID: 35924727 PMCID: PMC10476066 DOI: 10.1017/s0033291722002070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Successful interventions have been developed for smoking cessation although the success of smoking relapse prevention protocols has been limited. Cognitive behavioural therapy (CBT) in particular has been hampered by a high relapse rate. Because relapse can be due to conditions associated with tobacco consumption (such as drinking in bars with friends), virtual reality cue exposure therapy (VRCE) can be a potential tool to generate 3D interactive environments that simulate risk situations for relapse prevention procedures. METHODS To assess the effectiveness of VRCE with CBT, a comparative trial involving 100 smoking abstinent participants was designed with all required virtual environments (VE) created with an inexpensive graphic engine/game level editor. RESULTS Outcome measures confirmed the immersive and craving eliciting effect of these VEs. Results demonstrated that more participants in the VRCE group did not experience smoking relapse and that VRCE is at least as efficacious as traditional CBT in terms of craving reduction and decrease in nicotine dependence. Dropout and relapse rate in the VRCE group was noticeably lower than the CBT group. Aside from mood scores, no significant differences were found regarding the other scales. CONCLUSION The present clinical trial provides evidence that VRCE was effective in preventing smoking relapse. Improvement in technology and methodology for future research and applications is delineated.
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Affiliation(s)
- Eric Malbos
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
- Equipe Imothep, Institut Fresnel, UMR 7249, Aix-Marseille Université, CNRS, Ecole Centrale Marseille, Marseille, France
| | - Baptiste Borwell
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
| | - Mélodie Einig-Iscain
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
- Equipe Imothep, Institut Fresnel, UMR 7249, Aix-Marseille Université, CNRS, Ecole Centrale Marseille, Marseille, France
| | - Théo Korchia
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
| | - Robin Cantalupi
- Cognitive Psychology Lab, UMR 7290, Aix-Marseille University, Marseille, France
| | - Laurent Boyer
- CEReSS, EA 3279, Center, La Timone Faculty of Medicine, Aix-Marseille Université, Marseille, France
| | - Christophe Lancon
- Department of Adult Psychiatry, Conception University Hospital, Marseille, France
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Jimeno Sánchez J, Chabbar Boudet MC, Morlanes Gracia P, Laita Monreal S, López Perales CR, Cuko G, Albarrán Martín C, Garza Benito F. [Anti-smoking intervention in the acute phase of acute coronary syndrome: Is there additional benefit in patients included in a cardiac rehabilitation program?]. J Healthc Qual Res 2023; 38:105-111. [PMID: 35933320 DOI: 10.1016/j.jhqr.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Smoking is a challenge in secondary prevention after acute coronary syndrome (ACS). The objective was to assess whether the early anti-smoking intervention (ASI), in the acute hospitalization phase, improves the abstinence rate obtained during a cardiac rehabilitation program (CRP). METHODS Multicenter clinical trial in which smoker patients admitted for ACS were randomized 1:1 to receive or not ASI from the first day of admission. Upon discharge, both groups were referred to the CRP, performing abstinence controls using co-oximetry. Patients lost were considered smokers. RESULTS 72 patients were included, 58 men (80.5%), mean age 53 ± 8.1 years. They were admitted for ST elevation myocardial infarction 42 (58%), non-ST elevation myocardial infarction 29 (40%) and unstable angina 1 (1.3%). They smoked an average of 22 ± 11.3 cigarettes/day (pack-year index 37 ± 20). They completed the Richmond test (8.8 ± 1.3) and Fagestrom (5.69 ± 2.1). 36 patients (50%) were randomized to ASI, with no differences in the baseline characteristics of both groups. The dropout rate at the time of inclusion in CRP was higher in the ASI group (69 vs. 44%; p 0.034; OR 2.84), without statistical significance at discharge from the CRP (58 vs. 50%; p 0.478; OR 1.4) or at 12 months (58 vs. 44%; p 0.24; OR 1.75). CONCLUSIONS The ASI during admission significantly improves the smoking cessation rate at the time of inclusion in the CRP. Part of these beneficial effects are reduced in the follow-up losing statistical significance with respect to the control group.
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Affiliation(s)
| | - M C Chabbar Boudet
- Hospital Universitario Miguel Servet, Zaragoza, España; Hospital Nuestra Señora de Gracia, Zaragoza, España
| | | | | | | | - G Cuko
- Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - C Albarrán Martín
- Hospital Nuestra Señora de Gracia, Zaragoza, España; Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - F Garza Benito
- Hospital Nuestra Señora de Gracia, Zaragoza, España; Hospital Royo Villanova, Zaragoza, España
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Jones G, Lipson J, Nock MK. Associations between classic psychedelics and nicotine dependence in a nationally representative sample. Sci Rep 2022; 12:10578. [PMID: 35732796 PMCID: PMC9216303 DOI: 10.1038/s41598-022-14809-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Tobacco use is the single largest cause of preventable death worldwide, but none of the established treatments aimed at smoking cessation work for a majority of smokers. As such, there is an urgent need for interventions capable of reliably treating nicotine addiction. The use of classic psychedelics has been associated with lower odds of many forms of substance dependence. Here we tested whether lifetime use of classic psychedelics (tryptamine, lysergamide, and phenethylamine) is associated with lower odds of current nicotine dependence. We tested these associations in a sample of 214,505 adult participants in the National Survey on Drug Use and Health (2015–2019) using multivariable logistic regression models. Lifetime psilocybin use was associated with reduced odds of odds of current nicotine dependence (aOR 0.87–0.93). Lifetime use of peyote and mescaline also conferred reduced odds of multiple subdomains of a main nicotine dependence measure (Nicotine Dependence Syndrome Scale [NDSS]) (aOR 0.79–0.91). Conversely, lifetime use of LSD was associated with increased odds of nicotine dependence (aOR 1.17–1.24). Psilocybin, mescaline, and peyote use are associated with lowered odds of nicotine dependence. Experimental studies are needed to establish whether these associations are causal. These results make the case for further research into the efficacy of both tryptamine and phenethylamine psychedelics in promoting smoking cessation.
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Affiliation(s)
- Grant Jones
- Department of Psychology, Harvard University, 33 Kirkland St, Cambridge, MA, 02138, USA.
| | - Joshua Lipson
- Teacher's College, Columbia University, New York, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, 33 Kirkland St, Cambridge, MA, 02138, USA
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Daldegan-Bueno D, Maia LO, Massarentti CM, Tófoli LF. Ayahuasca and tobacco smoking cessation: results from an online survey in Brazil. Psychopharmacology (Berl) 2022; 239:1767-1782. [PMID: 35179623 DOI: 10.1007/s00213-022-06063-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 01/07/2022] [Indexed: 11/24/2022]
Abstract
RATIONALE Smoking-related disease is a major problem globally. Effective smoking cessation treatments are however limited. Increasing evidence suggests that psychedelics have potential as treatments for substance use disorders and may therefore prove an option in aiding smoking cessation. OBJECTIVES To establish which factors predict smoking cessation in people who reported quitting or reducing smoking following ayahuasca consumption. METHODS A retrospective cross-sectional mixed-method study (quantitative and qualitative design) was undertaken using data from an online survey evaluating peoples' experiences before and after drinking ayahuasca. Multivariate logistic regression was performed with smoking condition (cessation or reduction/relapse) as a dependent variable and demographics, smoking, ayahuasca-related variables and the mystical experience (MEQ30) as predicting factors. RESULTS A total of 441 responses were grouped according to self-reported smoking status: cessation (n = 305) or reduction/relapse (n = 136) smoking. Logistic regression showed that mystical experience (OR: 1.03; 95% CI [1.00-1.05]) and frequency of ayahuasca intake (OR: 2.16[1.00-4.70]) were protective factors, while positive mood (measured by the MEQ30) during the ayahuasca experience was a risk factor (OR: 0.91[0.85-0.97]). Qualitative thematic analysis identified eight themes (e.g. acquired awareness, spiritual experience, increased motivation) related to the ayahuasca experience and the process of smoking cessation/reduction. CONCLUSIONS Our results suggest that ayahuasca could be used as a potential tool for smoking cessation, and that effects may be mediated by mystical experience. Given the current burden of smoking-related disease and the limited treatment options, studies are needed to investigate the efficacy of psychedelics in smoking cessation.
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Affiliation(s)
- Dimitri Daldegan-Bueno
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz Campinas, Rua Tessália Vieira de Camargo 126, Campinas, São Paulo, 13083-887, Brazil
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - Lucas Oliveira Maia
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz Campinas, Rua Tessália Vieira de Camargo 126, Campinas, São Paulo, 13083-887, Brazil
| | - Carolina Marcolino Massarentti
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz Campinas, Rua Tessália Vieira de Camargo 126, Campinas, São Paulo, 13083-887, Brazil
| | - Luís Fernando Tófoli
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas, Cidade Universitária Zeferino Vaz Campinas, Rua Tessália Vieira de Camargo 126, Campinas, São Paulo, 13083-887, Brazil.
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Wittekind CE, Takano K, Sckopke P, Winkler MH, Werner GG, Ehring T, Rüther T. Efficacy of approach bias modification as an add-on to smoking cessation treatment: study protocol for a randomized-controlled double-blind trial. Trials 2022; 23:223. [PMID: 35313949 PMCID: PMC8935694 DOI: 10.1186/s13063-022-06155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Although effective treatments for smoking cessation are available, long-term abstinence is the exception rather than the norm. Accordingly, there is a need for novel interventions that potentially improve clinical outcome. Although implicit information processing biases, for example approach biases for smoking-related stimuli, are ascribed a dominant role in the maintenance of tobacco dependence, these biases are hardly targeted in current treatment. Past research has shown that so-called Approach Bias Modification (AppBM) trainings, aiming to modify this bias, lead to improved long-term abstinence in abstinent alcoholic inpatients when delivered as an add-on to treatment-as-usual. Findings on the efficacy of AppBM in smoking have been inconsistent. The present large-scale clinical trial pursues two goals. First, it aims to investigate the efficacy of AppBM as an add-on to treatment-as-usual in a representative sample of adult smokers. Second, possible mechanisms of change are investigated. Methods The study is a randomized-controlled, double-blind, parallel-group superiority trial. We aim at a final sample of at least 336 adult smokers. Participants are allocated with a 1:1:1 allocation ratio to one of the following conditions: (1) treatment-as-usual + AppBM, (2) treatment-as-usual + Sham, (3) treatment-as-usual only. During the add-on training, participants are presented smoking-related and positive pictures and are instructed to respond by either pushing or pulling a joystick, depending on the tilt of the pictures (5○ to the left/right). During AppBM, all smoking-related pictures are tilted in the direction that is associated with pushing, thereby aiming to train an avoidance bias for smoking. All positive pictures are tilted in the direction associated with pulling. During Sham, the contingency is 50/50. Participants are assessed before and after the intervention and at a 6-month follow-up. The primary outcome is prolonged abstinence, and secondary outcomes include smoking-related variables and psychological distress. Additionally, the motivational significance of smoking-related stimuli (i.e., approach bias, valence) is assessed with different experimental tasks (Approach-Avoidance Task; Single Target Implicit Association Test) and psychophysiological measures. Discussion This is the first large-scale clinical trial investigating the efficacy of AppBM as an add-on in smokers including a TAU only condition. Additionally, it is the first study to systematically investigate potential mechanisms mediating the effects of treatment on clinical outcome. Trial registration German Clinical Trials Register, DRKS00019221, 11/11/2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06155-6.
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Al-Hamdani M, Manly E. Harm reduction in tobacco control: where do we draw the line? J Public Health Policy 2022; 43:149-154. [PMID: 34997211 DOI: 10.1057/s41271-021-00327-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/21/2022]
Abstract
With substance abuse, harm reduction refers to reducing or replacing use of a harmful product with a less risky agent. But many advertised "non-pharmaceutical" harm reduction alternatives for tobacco smoking are problematic. Studies have revealed inconclusive results using agents including chewing tobacco and e-cigarettes to quit smoking and have demonstrated continued use of these agents. Many smoking harm reduction agents pose other health risks not found in traditional tobacco smoking. Given these limitations, efforts should focus on promoting nicotine replacement therapy, and other pharmacologic agents with a better chance of producing sustained smoking cessation. To address the harmful nature of many tobacco replacement products, public health should focus on regulating these alternatives with the same stringency as tobacco, and social marketing efforts should target evidence-based and safer pharmaceutical grade or behavioural alternatives.
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Affiliation(s)
| | - Eden Manly
- McMaster University, Hamilton, ON, Canada
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Salloum RG, Rojewski AM, Piper ME, Blalock JA, Borrelli B, Boyce LM, Minnix JA, Dogar O, Tomko RL, Jorenby DE, Kotsen C, Ostroff JS. Reporting Treatment Fidelity in Behavioral Tobacco Treatment Clinical Trials: Scoping Review and Measurement Recommendations. Nicotine Tob Res 2022; 24:150-159. [PMID: 34197617 PMCID: PMC9013002 DOI: 10.1093/ntr/ntab140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Adoption of rigorous standards for reporting treatment fidelity is essential for advancing discovery, validation, and implementation of behavioral treatments. Whereas the NIH Behavior Change Consortium (BCC) developed an assessment tool to assess the quality of reporting and monitoring of treatment fidelity across health behavior change interventions, it has not yet been applied specifically to treatment fidelity in behavioral tobacco treatment trials. AIMS AND METHODS We conducted a scoping review of peer-reviewed, clinical trials of behavioral adult tobacco treatment interventions published in English between 2006 and 2018. Using the BCC treatment fidelity checklist, articles were coded for the presence or absence of various treatment fidelity strategies within each of 5 domains: Design, Training, Delivery, Receipt, and Enactment. Eligible articles (N = 755) were coded by two independent coders. RESULTS The proportion of reporting strategies varied within the fidelity domains, ranging from 5.2% to 96.3% in Design, 1.9% to 24.9% in Training, 2.6% to 32.3% in Delivery, 5.2% to 44.3% in Receipt, and 6.7% to 43.2% in Enactment. The mean proportion of adherence to treatment fidelity strategies within each domain was: Design (68%), Training (14%), Delivery (15%), Receipt (16%), and Enactment (25%). Only 11 studies achieved ≥80% reporting across >1 fidelity domain. There was no evidence for improvement in fidelity reporting across the 13-year time frame from the initial BCC publication to the present. CONCLUSIONS These findings illustrate the lack of consistency in fidelity reporting in tobacco treatment trials and underscore the challenges faced in evaluating rigor and reproducibility, as well as interpretation and dissemination of findings. Recommendations are made for improving fidelity reporting in tobacco treatment trials. IMPLICATIONS The SRNT Treatment Research Network sponsored a scoping review to summarize the current state of reporting treatment fidelity and make recommendations for best practices in reporting fidelity in tobacco treatment trials. The review identified a lack of consistency in fidelity reporting, illustrating the challenges faced in evaluating rigor, and reproducibility, as well as interpretation and dissemination of findings.
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Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, College of Medicine, Gainesville, FL, USA
| | - Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, WI, USA
| | - Janice A Blalock
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Belinda Borrelli
- Center for Behavioral Science Research, Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Lindsay M Boyce
- Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer A Minnix
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Omara Dogar
- Department of Health Sciences, University of York, York, United Kingdom
| | - Rachel L Tomko
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Douglas E Jorenby
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, WI, USA
| | - Chris Kotsen
- Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Johnson MW. Classic Psychedelics in Addiction Treatment: The Case for Psilocybin in Tobacco Smoking Cessation. Curr Top Behav Neurosci 2022; 56:213-227. [PMID: 35704271 DOI: 10.1007/7854_2022_327] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This manuscript reviews research suggesting that classic psychedelics (5-HT2A receptor agonists) are effective in treating addictions including tobacco use disorder. I review historical research from the 1950s to 1970s suggesting that classic psychedelics are associated with addiction recovery across pharmacologically distinct drugs of addiction. I then review anthropological reports about ceremonial use of classic psychedelics and epidemiological studies that are consistent with anti-addiction efficacy. I review modern research using psilocybin in the treatment of alcohol use disorder and tobacco use disorder. Both lines of research show high success rates in preliminary studies. General anti-addiction efficacy across a variety of classes of addictive drugs is consistent with the notion that the persisting positive behavior change prompted by psychedelic therapy is due to amplification of psychotherapeutic processes. Future research should examine classic psychedelic treatment of additional substance use disorders including for opioids, cocaine, methamphetamine, and cannabis, and other disorders broadly characterized as addictions (e.g., obesity, problem gambling, hypersexual disorder). Future research should also explore addiction treatments with other classic psychedelics including LSD, mescaline, DMT, 5-MeO-DMT, and yet-to-be-discovered compounds. Experimental research is also needed to test different protocols for the delivery of classic psychedelic therapy for addictions. Given the staggering society costs of substance use disorders, including the mortality caused by tobacco smoking, it is critical that public funding be made available for scientists to follow up on promising early findings of classic psychedelics in addiction treatment. The costs and risks of not conducting such research are too great.
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Affiliation(s)
- Matthew W Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Tseng TS, Celestin MD, Yu Q, Li M, Luo T, Moody-Thomas S. Use of Geographic Information System Technology to Evaluate Health Disparities in Smoking Cessation Class Accessibility for Patients in Louisiana Public Hospitals. Front Public Health 2021; 9:712635. [PMID: 34476230 PMCID: PMC8406529 DOI: 10.3389/fpubh.2021.712635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Research has shown cigarette smoking is a major risk factors for many type of cancer or cancer prognosis. Tobacco related health disparities were addressed continually in cancer screening, diagnosis, treatment, prevention and control. The present study evaluated the health disparities in attendance of smoking cessation counseling classes for 4,826 patients scheduled to attend between 2005 and 2007. Of 3,781 (78.4%) patients with records to calculate the distance from their home domicile to counseling sites using Geographic Information System technology, 1,435 (38%) of smokers who attended counseling had shorter travel distances to counseling sites (11.6 miles, SD = 11.29) compared to non-attendees (13.4 miles, SD = 16.72). When the travel distance was >20 miles, the estimated odds of attending decreased with greater travel distance. Smokers who actually attended were more likely to be older, female, White, living in urban areas, and receiving free healthcare. After controlling for other socio-demographic factors, shorter distances were associated with greater class attendance, and individuals more likely to attend included those that lived closer to the counseling site and in urban settings, were female, White, commercially insured, and older than their counterparts. These findings have the potential to provide important insights for reducing health disparities for cancer prevention and control, and to improve shared decision making between providers and smokers.
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Affiliation(s)
- Tung Sung Tseng
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Michael D Celestin
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Qingzhao Yu
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Mirandy Li
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States.,Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, United States
| | - Ting Luo
- Moores Cancer Center, School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Sarah Moody-Thomas
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
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12
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Jones CM, Schüz B. Stable and momentary psychosocial correlates of everyday smoking: An application of Temporal Self-Regulation Theory. J Behav Med 2021; 45:50-61. [PMID: 34363146 PMCID: PMC8818630 DOI: 10.1007/s10865-021-00248-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
Smoking is one of the leading causes of non-communicable disease mortality and morbidity. Smoking behaviour is determined by both stable, person-level (e.g., motivation, nicotine dependence) and variable, situation-level factors (e.g., urges, cues). However, most theoretical approaches to understanding health behaviours so far have not integrated these two spheres of influence. Temporal Self-Regulation Theory (TST) integrates these person-level and situation-level factors, but has not yet been comprehensively applied to predicting smoking behaviour. We use Ecological Momentary Assessment to examine the utility of TST in predicting daily smoking. 46 smokers reported individual and environmental cues right after smoking and at random time points during the day. Cognitions, self-control, past behaviour, and nicotine dependence were assessed at baseline. Multi-level logistic regressions show that smoking is largely guided by momentary cues, but individual motivation can buffer their influence. This suggests that TST is a useful integrative approach to understand modifiable determinants of smoking and thus intervention targets.
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Affiliation(s)
- Christopher M Jones
- Institute of Public Health and Nursing Research, University of Bremen, Grazer Str. 4, 28359, Bremen, Germany.
| | - Benjamin Schüz
- Institute of Public Health and Nursing Research, University of Bremen, Grazer Str. 4, 28359, Bremen, Germany
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Yaden DB, Berghella AP, Regier PS, Garcia-Romeu A, Johnson MW, Hendricks PS. Classic psychedelics in the treatment of substance use disorder: Potential synergies with twelve-step programs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103380. [PMID: 34329952 DOI: 10.1016/j.drugpo.2021.103380] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 12/20/2022]
Abstract
Several pilot studies have provided evidence supporting the potential of classic psychedelics like psilocybin in the treatment of substance use disorders (SUDs). If larger trials confirm efficacy, classic psychedelic-assisted psychotherapy may eventually be integrated into existing addiction treatments such as cognitive behavioral therapy, contingency management, and medication-assisted therapies. Many individuals seeking treatment for SUDs also join twelve-step facilitation (TSF) programs like Alcoholics Anonymous (AA), which are among the most widely available and accessed treatments for alcohol use disorder worldwide. For such individuals, engaging in classic psychedelic-assisted psychotherapy could be seen as controversial, as members of AA/TSF programs have historically rejected medication-assisted treatments in favor of a pharmacotherapy-free approach. We argue that classic psychedelics and the subjective experiences they elicit may represent a special, more compatible case than conventional medications. In support of this claim, we describe Bill Wilson's (the founder of AA) little known experiences with psychedelics and on this basis, we argue that aspects of classic psychedelic treatments could complement AA/TSF programs. We provide a review of clinical trials evaluating psychedelics in the context of SUDs and discuss their potential large-scale impact should they be ultimately integrated into AA/TSF.
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Affiliation(s)
- David B Yaden
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences.
| | - Andrea P Berghella
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences; Thomas Jefferson University MD/PhD Program, Sidney Kimmel Medical College and Jefferson College of Life Sciences
| | - Paul S Regier
- University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry
| | - Albert Garcia-Romeu
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences
| | - Matthew W Johnson
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences
| | - Peter S Hendricks
- University of Alabama at Birmingham, Ryals School of Public Health, Department of Health Behavior
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14
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Mehta R, Pichel D, Chen-Ku CH, Raffaele P, Méndez Durán A, Padilla F, Arango Alvarez JJ, Esteban Costa Gil J, Esteban Gómez Mesa J, Giorgi M, Lahsen R, Sposito AC. Latin American Expert Consensus for Comprehensive Management of Type 2 Diabetes from a Metabolic-Cardio-Renal Perspective for the Primary Care Physician. Diabetes Ther 2021; 12:1-20. [PMID: 33325006 PMCID: PMC7843679 DOI: 10.1007/s13300-020-00961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022] Open
Abstract
Growing scientific evidence from studies on type 2 diabetes (T2D) has recently led to a better understanding of the associated metabolic-cardio-renal risks. The large amount of available information makes it essential to have a practical guide that summarizes the recommendations for the initial management of patients with T2D, integrating different aspects of endocrinology, cardiology, and nephrology. The expert consensus presented here does not attempt to summarize all the evidence in this regard but rather attempts to define practical summary recommendations for the primary care physician to improve the clinical prognosis and management of patients with T2D, while ensuring economic sustainability of health systems, beyond glycemic control.
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Affiliation(s)
- Roopa Mehta
- Metabolic Diseases Research Unit (UIEM), National Institute of Medical Sciences and Nutrition Salvador Zubirán (INCMNSZ), Vasco De Quiroga 15, Belisario Dominguez, Tlalpan, 14200, Mexico.
| | - Daniel Pichel
- Department of Medicine/Cardiology, Hospital Paitilla, Calle 53, Ave Balboa, Urb. Marbella, Panama City, 00134, Panama
| | - Chih Hao Chen-Ku
- Clínica Los Yoses, San Pedro Montes de Oca, San José, Costa Rica
| | - Pablo Raffaele
- Department of Nephrology, Fundación Favaloro University Hospital, Buenos Aires, 1093, Argentina
| | - Antonio Méndez Durán
- Coordinacion de Planeacion de Infraestructura Medica, Instituto Mexicano del Seguro Social, C.P. 6700, Mexico City, Mexico
| | - Francisco Padilla
- Cardiología Clínica e Intervencionista, 44670, Guadalajara, Jalisco, Mexico
| | | | | | | | - Mariano Giorgi
- Cardiology Section, Cardiovascular Prevention Unit, CEMIC, Buenos Aires, Argentina
| | - Rodolfo Lahsen
- Centro de Diabetes Adultos, Clinica Las Condes, 7591047, Santiago, Chile
| | - Andrei C Sposito
- Department of Cardiology, State University of Campinas (Unicamp), Campinas, Brazil
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15
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Mall A, Vyas S. Community-based interventional study for tobacco cessation in urban slums of Ahmedabad City: A cluster-randomized trial. Indian J Community Med 2021; 46:641-644. [PMID: 35068726 PMCID: PMC8729268 DOI: 10.4103/ijcm.ijcm_1016_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Materials and Methods: Results: Conclusion:
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16
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Dickreuter J, Schmoor C, Bengel J, Jähne A, Leifert JA. Efficacy of a short-term residential smoking cessation therapy versus standard outpatient group therapy ('START-Study'): study protocol of a randomized controlled trial. Trials 2020; 21:562. [PMID: 32576275 PMCID: PMC7310333 DOI: 10.1186/s13063-020-04253-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In Germany, evidence-based outpatient smoking cessation therapies are widely available. Long-term abstinence rates, however, are limited. Studies suggest that short-term residential therapy enables a higher level of environmental control, more intense contact and greater support among patients and from therapists, which could result in higher abstinence rates. The aim of the current START-study is to investigate the long-term efficacy of a short-term residential therapy exclusively for smoking cessation, conducted by a mobile team of expert therapists. METHODS A randomized controlled trial (RCT) is conducted to examine the efficacy of residential behavior therapeutic smoking cessation therapy compared to standard outpatient behavior therapeutic smoking cessation group therapy. Adult smokers consuming 10 or more cigarettes per day, who are willing to stop smoking, are randomized in a ratio of 1:1 between therapy groups. The primary endpoint is sustained abstinence for 6-month and 12-month periods. Secondary endpoints include smoking status after therapy, 7-day point abstinence after the 6-month and 12-month follow-ups, level of physical dependence, cost-effectiveness, use of nicotine replacement products, health-related quality of life, self-efficacy expectation for tobacco abstinence, motivational and volitional determinants of behavior change, self-reported depressive symptom severity, adverse events and possible side effects. Assessments will take place at baseline, post-therapy, and at 6-month and 12-month intervals after smoking cessation. DISCUSSION There is a high demand for long-term effective smoking cessation therapies. This study represents the first prospective RCT to examine the long-term efficacy of a residential smoking cessation therapy program compared to standard outpatient group therapy as an active control condition. The residential therapeutic concept may serve as a new model to substantially enhance future cessation therapies and improve the understanding of therapeutic impact factors on tobacco abstinence. Utilizing a mobile team, the model could be applied efficiently to medical centers that do not have permanent and trained personnel for smoking cessation at their disposal. TRIAL REGISTRATION German Register for Clinical Trials (Deutsches Register für Klinische Studien), DRKS00013466. Retrospectively registered on 1 April 2019. https://www.drks.de/drks_web/navigate.do?navigationId=start.
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Affiliation(s)
- Jonas Dickreuter
- Comprehensive Cancer Center, Prevention Team CMPT, University Medical Center Freiburg, Elsässerstraße 2, 79110, Freiburg, Germany.
| | - Claudia Schmoor
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University Medical Center Freiburg, Elsässerstraße 2, 79110 Freiburg, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Engelberger Straße 41, 79085, Freiburg, Germany
| | - Andreas Jähne
- Rhein-Jura Klinik, Schneckenhalde 13, 79713, Bad Säckingen, Germany
| | - Jens A Leifert
- Comprehensive Cancer Center, Prevention Team CMPT, University Medical Center Freiburg, Elsässerstraße 2, 79110, Freiburg, Germany
- Breisgau-Klinik, Herbert-Hellmann-Allee 37, 79189, Bad Krozingen, Germany
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17
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Kotsen C, Santorelli ML, Bloom EL, Goldstein AO, Ripley-Moffitt C, Steinberg MB, Burke MV, Foulds J. A Narrative Review of Intensive Group Tobacco Treatment: Clinical, Research, and US Policy Recommendations. Nicotine Tob Res 2020; 21:1580-1589. [PMID: 30124924 DOI: 10.1093/ntr/nty162] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/14/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Clinical practice guidelines recommend comprehensive treatment for tobacco dependence including pharmacotherapies and behavioral interventions. Group counseling may deliver unique treatment aspects not available with other modalities. This manuscript provides a narrative review of group treatment outcomes from real-world practice settings and complements recent meta-analyses of randomized controlled trials (RCTs). Our primary goals were to determine whether group treatments delivered in these settings have yielded similar quit rates compared to individual treatment and to provide recommendations for best practices and policy. METHODS Group treatment was defined as occurring in a clinical or workplace setting (ie, not provided as part of a research study), led by a professionally trained clinician, and offered weekly over several weeks. English language PubMed articles from January 2000 to July 2017 were searched to identify studies that included outcomes from both group and individual treatment offered in real-world settings. Additional data sources meeting our criteria were also included. Reports not using pharmacotherapy and research studies (eg, RCTs) were excluded. The primary outcome was short-term, carbon monoxide (CO)-validated point prevalence abstinence (4-week postquit date). RESULTS The review included data from 11 observational studies. In all cases, group treatment(s) had higher 4-week CO-validated quit rates (range: 35.5%-67.3%) than individual treatment(s) (range: 18.6%-53.3%). CONCLUSIONS Best practice group treatments for tobacco dependence are generalizable from research to clinical settings and likely to be at least as effective as intensive individual treatment. The added advantages of efficiency and cost-effectiveness can be significant. Group treatment is feasible in various settings with good results. IMPLICATIONS A major barrier to achieving high rates of tobacco abstinence is under-utilization of evidence-based treatment interventions. This review demonstrates the effectiveness and utility of group treatment for tobacco dependence. Based on the available data described in this narrative review in conjunction with existing RCT data, group treatment for tobacco dependence should be established and available in all behavioral health and medical settings. Group tobacco treatment is now one of the mandated reimbursable tobacco treatment formats within the US health care system, creating enormous opportunities for widespread clinical reach. Finally, comprehensive worksite group programs can further extend impact.
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Affiliation(s)
- Chris Kotsen
- Tobacco Quitcenter, Lung Cancer Institute, Steeplechase Cancer Center, RWJ Barnabas Health, Robert Wood Johnson Barnabas Health University Hospital Somerset, Somerville, NJ
| | - Melissa L Santorelli
- Community Health and Wellness Unit, New Jersey Department of Health, State of New Jersey, Trenton, NJ
| | - Erika Litvin Bloom
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
- Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Adam O Goldstein
- Tobacco Intervention Programs, Department of Family Medicine, University of North Carolina, Chapel Hill, NC
| | - Carol Ripley-Moffitt
- Nicotine Dependence Program, Department of Family Medicine, University of North Carolina, Chapel Hill, NC
| | - Michael B Steinberg
- Rutgers Tobacco Dependence Program, Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Jonathan Foulds
- Population Health and Cancer Control Program, Cancer Institute, College of Medicine, Penn State University, Hershey, PA
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Wray JM, Funderburk JS, Acker JD, Wray LO, Maisto SA. A Meta-Analysis of Brief Tobacco Interventions for Use in Integrated Primary Care. Nicotine Tob Res 2019; 20:1418-1426. [PMID: 29059419 DOI: 10.1093/ntr/ntx212] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/15/2017] [Indexed: 11/14/2022]
Abstract
Introduction The integration of behavioral health services in primary care settings presents an opportunity to enhance the delivery of tobacco cessation interventions in the primary care setting, but guidance on evidence-based treatments for tobacco use disorder that fits the brief format of integrated primary care (IPC) is limited. This meta-analysis summarizes the outcomes of brief behavioral interventions targeting tobacco use that can be delivered in IPC settings. Methods A literature search was conducted to locate empirical studies examining tobacco cessation interventions that could be implemented in an IPC setting. A random effects meta-analytic approach was utilized with odds ratios as the effect size. Subgroup analyses were conducted to determine the extent to which a number of study, participant, and intervention characteristics affected treatment outcome. Results A total of 36 studies were included (n = 12975 patients). Patients in the intervention groups exhibited significantly greater odds of smoking cessation compared with those in the comparison groups (OR = 1.78, p < .001). Subgroup analyses did not reveal significant sources of heterogeneity attributable to moderators such as methodological quality, gender, bioverification, follow-up time period, or intervention characteristics (such as setting, type, or length of intervention). Conclusions Brief tobacco cessation interventions that can be delivered in IPC settings were found to be effective. Future research in this area might evaluate ways to improve the dissemination and implementation of these types of interventions in IPC settings. Implications The integration of behavioral health services into primary care presents a unique opportunity to increase the delivery of tobacco cessation interventions, as behavioral health providers in these settings are experts in behavior change interventions and may have more time to deliver these interventions than primary care providers. Results from the current meta-analysis demonstrate that brief tobacco cessation interventions that can be implemented in the IPC setting are effective. Future research in this area might examine ways to improve the dissemination and implementation of brief interventions for tobacco use in IPC settings.
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Affiliation(s)
- Jennifer M Wray
- Ralph H. Johnson VA Medical Center, Charleston, SC.,VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY
| | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY.,Department of Psychology, Syracuse University, Syracuse, NY.,Department of Psychiatry, University of Rochester, Rochester, NY
| | - John D Acker
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY
| | - Laura O Wray
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY.,Division of Geriatrics and Palliative Medicine, University at Buffalo, Buffalo, NY.,Department of Psychology, University at Buffalo, Buffalo, NY
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, VA Western NY Healthcare System, Buffalo, NY and Syracuse VA Medical Center, Syracuse NY.,Department of Psychology, Syracuse University, Syracuse, NY
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Jawad A, Patel D, Brima N, Stephenson J. Alcohol, smoking, folic acid and multivitamin use among women attending maternity care in London: A cross-sectional study. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 22:100461. [PMID: 31494357 DOI: 10.1016/j.srhc.2019.100461] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 08/05/2019] [Accepted: 08/27/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study describes the patterns of change in health behaviours that pregnant women adopt before and during pregnancy. STUDY DESIGN A cross-sectional survey of pregnant women asked questions about pregnancy planning, health knowledge, and health behaviour. Analysis was descriptive with associations examined using logistic regression models. MAIN OUTCOME MEASURES Health behaviours before and during pregnancy (smoking, alcohol consumption, and folic acid and multivitamin (supplement) intake), and recall of healthcare professional advice. RESULTS 1173 women completed the survey (mean age 32 ± 5 years, 68% white) of whom 73% indicated that their pregnancy was highly planned. 38% of women reported having never smoked, 45% quit smoking before becoming pregnant, and fewer (5%, 95% CI 3-6%) reported currently smoking. Current smokers reported reduced cigarette consumption compared to pre-pregnancy, and higher recall of health professional information. Nine percent (95% CI 5-8%) reported currently drinking, reducing the number of units consumed from 6 units weekly before pregnancy (IQR 2-10) to 1 unit weekly during pregnancy (IQR 1-2, p < 0.001). Most (62%) women were currently taking supplements, of whom 81% reported daily use. Women with more planned pregnancies had higher odds of adopting healthier behaviours of stopping smoking or drinking before pregnancy compared to those who stopped during pregnancy or continued the behaviour. CONCLUSIONS Most women adopted one or more healthy behaviours during pregnancy, with a small minority continuing to smoke or drink alcohol. For women who continued smoking in pregnancy and recalled information from health professionals, additional tailored approaches need to be explored.
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Affiliation(s)
- Aalaa Jawad
- Public Health Training Programme, Stewart House, London WC1B 5DN, United Kingdom.
| | - Dilisha Patel
- Reproductive Medicine, Institute for Women's Health, UCL, London, United Kingdom.
| | | | - Judith Stephenson
- Reproductive Medicine, Institute for Women's Health, UCL, London, United Kingdom.
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Kim BS, Lim YH, Shin JH, Kim SH, Roh S, Choi YW, Shin J, Park JK, Kim KS. The Impact of Aversive Advice During Percutaneous Coronary Intervention on Smoking Cessation in Patients With Acute Coronary Syndrome. Glob Heart 2019; 14:253-257. [PMID: 31103401 DOI: 10.1016/j.gheart.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Smoking cessation is important to prevent recurrence of acute coronary syndrome (ACS), but even in patients with ACS, smoking is hard to quit. OBJECTIVES This study hypothesized that aversive advice during the percutaneous coronary intervention (PCI) procedure works effectively to promote smoking cessation in patients with ACS. METHODS This study was conducted as a prospective, single-blinded, randomized controlled trial. A total of 66 patients were randomly assigned to an aversive advice group or a control group and instructed to visit the outpatient clinic 1, 4, and 24 weeks after discharge. In the aversive advice group, a physician who did not participate in the patient follow-up said the following 3 sentences to the patients during the PCI procedure: "Smoking caused your chest pain"; "If you do not stop smoking right now, this pain will come again"; and "The next time you feel this pain you will probably die." All patients received usual advice on the importance of quitting smoking. RESULTS At 24 weeks after discharge, the smoking cessation rate was higher in the aversive advice group than in the control group. In a multivariable logistic regression analysis, after adjustment for age, smoking quantity, alcohol consumption, and disease severity, the result was maintained (odds ratio = 4.47, 95% confidence interval: 1.50 to 13.34). CONCLUSIONS Aversive advice during a PCI procedure is effective at smoking cessation in patients with ACS. A physician's attention and involvement during the PCI procedure improves the rate of smoking cessation in patients with ACS.
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Affiliation(s)
- Byung Sik Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jeong Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri City, Republic of Korea
| | - Seok Hyeon Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Sungwon Roh
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Yeon Woo Choi
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jin-Kyu Park
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Kyung-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea.
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21
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Web-based Approach Bias Modification in smokers: A randomized-controlled study. Behav Res Ther 2019; 116:52-60. [DOI: 10.1016/j.brat.2018.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 01/25/2023]
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Melka AS, Chojenta CL, Holliday EG, Loxton DJ. Effectiveness of pharmacotherapy for smoking cessation: protocol for umbrella review and quality assessment of systematic reviews. Syst Rev 2018; 7:210. [PMID: 30474559 PMCID: PMC6260841 DOI: 10.1186/s13643-018-0878-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 11/07/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In the long term, smoking cessation can decrease the risk of cancer, stroke, and heart attacks and improve overall survival. The aim of the proposed umbrella review is to summarize existing systematic reviews that assessed the effects of pharmacological interventions for smoking cessation and to evaluate the methodological quality of previously conducted systematic reviews. METHODS Databases such as the Cochrane Library, PubMed, MEDLINE, EMBASE, CINAHIL PsychINFO Web of Science, Conference Papers Index, Scopus, and Google Scholar will be used to retrieve reviews. Systematic reviews which included only randomized control trials will be considered in this review. The primary outcome will be prolonged abstinence from smoking for a minimum of 6 months follow-up, and the secondary outcome will be point abstinence rate from smoking of less than 6 months follow-up but more than 7 days. Methodological quality of the included reviews will be assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool, which contains 16 domains. Two authors will screen the titles and abstracts of all reviews obtained by the search strategy, assess the full text of selected articles for inclusion, and extract data independently. The quality appraisal will be also assessed by two authors (AM, CC) independently, and Cohen's Kappa statistic will be used to assess inter-ratter agreement. The findings of the study will be narrated qualitatively to describe the effect of different pharmacotherapy on smoking cessation. DISCUSSION The World Health Organization recommends treatment of tobacco dependence as one approach in its comprehensive tobacco control policy. To date, many trials and systematic reviews have been conducted to assess the effectiveness of pharmacotherapy for smoking cessation. Therefore, the findings of the umbrella review will improve clinical decision-making and be used as a baseline for future studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017080906.
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Affiliation(s)
- Alemu S. Melka
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Catherine L. Chojenta
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Elizabeth G. Holliday
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Deborah J. Loxton
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia
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Noorani T, Garcia-Romeu A, Swift TC, Griffiths RR, Johnson MW. Psychedelic therapy for smoking cessation: Qualitative analysis of participant accounts. J Psychopharmacol 2018; 32:756-769. [PMID: 29938565 DOI: 10.1177/0269881118780612] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Recent pilot trials suggest feasibility and potential efficacy of psychedelic-facilitated addiction treatment interventions. Fifteen participants completed a psilocybin-facilitated smoking cessation pilot study between 2009 and 2015. AIMS The aims of this study were as follows: (1) to identify perceived mechanisms of change leading to smoking cessation in the pilot study; (2) to identify key themes in participant experiences and long-term outcomes to better understand the therapeutic process. METHODS Participants were invited to a retrospective follow-up interview an average of 30 months after initial psilocybin sessions. Semi-structured interviews were conducted with 12 of the 15 participants. Data were analysed using thematic analysis. RESULTS Participants reported gaining vivid insights into self-identity and reasons for smoking from their psilocybin sessions. Experiences of interconnectedness, awe, and curiosity persisted beyond the duration of acute drug effects. Participants emphasised that the content of psilocybin experiences overshadowed any short-term withdrawal symptoms. Preparatory counselling, strong rapport with the study team, and a sense of momentum once engaged in the study treatment were perceived as vital additional factors in achieving abstinence. In addition, participants reported a range of persisting positive changes beyond smoking cessation, including increased aesthetic appreciation, altruism, and pro-social behaviour. CONCLUSIONS The findings highlight the value of qualitative research in the psychopharmacological investigation of psychedelics. They describe perceived connections between drug- and non-drug factors, and provide suggestions for future research trial design and clinical applications.
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Affiliation(s)
- Tehseen Noorani
- 1 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,2 Department of Anthropology, Durham University, UK
| | - Albert Garcia-Romeu
- 3 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas C Swift
- 3 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,4 RiverStyx Foundation, Kirkland, Washington, DC, USA.,Thomas C Swift has been employed as a Casual-As Needed Research Program Assistant at Johns Hopkins University on a project independent of this research
| | - Roland R Griffiths
- 3 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,5 Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew W Johnson
- 3 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
Over 30% of the nearly 1 million North Americans hospitalized annually with an acute coronary syndrome (ACS) are smokers. Despite a substantially increased risk of morbidity and mortality, 2/3 of patients who quit smoking after ACS return to smoking within 1 year. To summarize the evidence of smoking cessation in patients hospitalized after ACS, we systematically reviewed all randomized controlled trials of pharmacologic and behavioral smoking cessation therapies in patients with ACS. In addition, we reviewed the clinical considerations surrounding the use of smoking cessation therapies, including their broad mechanisms of action and possible alternative treatments, including cardiac rehabilitation programs and electronic cigarettes. A total of 7 randomized controlled trials met our inclusion criteria (4 pharmacotherapies and 3 behavioral therapies). In pharmacologic trials, only varenicline increased point prevalence abstinence at 12 months. Behavioral interventions produced significantly improved abstinence rates at 6 and 12 months. However, these studies had substantial limitations affecting their generalizability. Overall, currently available smoking cessation therapies are limited in their efficacy in patients hospitalized after ACS. Because of the relative scarcity of data and the urgency of establishing clinical guidelines, there is a critical need to continue examining the efficacy and safety of smoking cessation interventions in patients hospitalized after ACS.
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Baskerville NB, Shuh A, Wong-Francq K, Dash D, Abramowicz A. LGBTQ Youth and Young Adult Perspectives on a Culturally Tailored Group Smoking Cessation Program. Nicotine Tob Res 2018; 19:960-967. [PMID: 28339649 PMCID: PMC5896477 DOI: 10.1093/ntr/ntx011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/13/2017] [Indexed: 11/12/2022]
Abstract
Introduction The prevalence of smoking among LGBTQ youth and young adults (YYAs) is much higher than that of non-LGBTQ young people. The current study explored LGBTQ YYA perceptions of a culturally tailored group smoking cessation counselling program, along with how the intervention could be improved. Methods We conducted focus groups (n = 24) with 204 LGBTQ YYAs in Toronto and Ottawa, Canada. Open-ended questions focused on their feelings, likes and dislikes, concerns and additional ideas for a culturally tailored group cessation counselling intervention. Focus group transcripts were coded thematically and analyzed. Results Overall, YYAs were ambivalent towards the concept of a culturally tailored, group cessation counselling program. Although several participants were attracted to the LGBTQ friendly and social benefits of such a program (eg, good support system), many also had concerns. Particularly, the possibility that other group members might trigger them to smoke was a frequently stated issue. Focus group members also noted lack of motivation to attend the group, and that the group program may be inaccessible depending on where and when the program was offered. Several suggestions were made as to how to ameliorate the expressed issues related to inaccessibility or lack of attractiveness. Conclusions This study is among the first to gain the perspectives of LGBTQ YYAs on culturally tailored group cessation strategies in Canada. We identified components of group cessation programs that are both favored and not favored among LGBTQ YYAs, as well as suggestions as to how to make group cessation programs more appealing. Implications This study is particularly relevant as smoking cessation programs are one of the most commonly offered and published cessation interventions for the LGBTQ community, yet little is understood in terms of preferences of LGBTQ YYA smokers. Given the disparity in the prevalence of smoking among LGBTQ young people compared to their non-LGBTQ peers, research on effective intervention strategies for this population is needed. Findings from this study can assist practitioners and researchers in designing interventions.
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Affiliation(s)
| | - Alanna Shuh
- Propel Centre for Population Health Impact, University of Waterloo,Waterloo, Canada
| | - Katy Wong-Francq
- Propel Centre for Population Health Impact, University of Waterloo,Waterloo, Canada
| | - Darly Dash
- Propel Centre for Population Health Impact, University of Waterloo,Waterloo, Canada
| | - Aneta Abramowicz
- Propel Centre for Population Health Impact, University of Waterloo,Waterloo, Canada
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Rosembaun A, Rojas P, Rodriguez MV, Barticevic N, Rivera Mercado S. Brief interventions to promote behavioral change in primary care settings, a review of their effectiveness for smoking, alcohol and physical inactivity. Medwave 2018; 18:e7148. [PMID: 29385118 DOI: 10.5867/medwave.2018.01.7148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/20/2017] [Indexed: 11/27/2022] Open
Abstract
The brief intervention is a therapeutic strategy suggested to address behavioral changes associated with risk factors for chronic non-communicable diseases and there is ample evidence of its effectiveness. However, this evidence is sustained by various definitions of brief intervention, a fact that makes the clinical application of this strategy difficult. This literature review article aimed to conduct a search for systematic reviews in the Epistemonikos database in order to identify common factors in the definition of brief intervention and summarize some brief intervention strategies frequently used in primary health care. It also seeks to describe their effectiveness, for three risk factors: tobacco, alcohol and physical activity, within this clinical context.
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Affiliation(s)
- Andrés Rosembaun
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. Address: Avenida Libertador Bernardo OHiggins 340, Santiago, Chile.
| | - Pedro Rojas
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Victoria Rodriguez
- Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Barticevic
- Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Solange Rivera Mercado
- Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Andreu CI, Cosmelli D, Slagter HA, Franken IHA. Effects of a brief mindfulness-meditation intervention on neural measures of response inhibition in cigarette smokers. PLoS One 2018; 13:e0191661. [PMID: 29370256 PMCID: PMC5784955 DOI: 10.1371/journal.pone.0191661] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/09/2018] [Indexed: 12/11/2022] Open
Abstract
Research suggests that mindfulness-practices may aid smoking cessation. Yet, the neural mechanisms underlying the effects of mindfulness-practices on smoking are unclear. Response inhibition is a main deficit in addiction, is associated with relapse, and could therefore be a candidate target for mindfulness-based practices. The current study hence investigated the effects of a brief mindfulness-practice on response inhibition in smokers using behavioral and electroencephalography (EEG) measures. Fifty participants (33 females, mean age 20 years old) underwent a protocol of cigarette exposure to induce craving (cue-exposure) and were then randomly assigned to a group receiving mindfulness-instructions or control-instructions (for 15 minutes approximately). Immediately after this, they performed a smoking Go/NoGo task, while their brain activity was recorded. At the behavioral level, no group differences were observed. However, EEG analyses revealed a decrease in P3 amplitude during NoGo vs. Go trials in the mindfulness versus control group. The lower P3 amplitude might indicate less-effortful response inhibition after the mindfulness-practice, and suggest that enhanced response inhibition underlies observed positive effects of mindfulness on smoking behavior.
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Affiliation(s)
- Catherine I. Andreu
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Diego Cosmelli
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
- Centro Interdisciplinario de Neurociencias, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Heleen A. Slagter
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Ingmar H. A. Franken
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Bruce Baskerville N, Wong K, Shuh A, Abramowicz A, Dash D, Esmail A, Kennedy R. A qualitative study of tobacco interventions for LGBTQ+ youth and young adults: overarching themes and key learnings. BMC Public Health 2018; 18:155. [PMID: 29347920 PMCID: PMC5774159 DOI: 10.1186/s12889-018-5050-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/10/2018] [Indexed: 12/23/2022] Open
Abstract
Background Smoking prevalence is very high among lesbian, gay, bisexual, transgendered and queer (LGBTQ+) youth and young adults (YYA) compared to non-LGBTQ+ YYA. A knowledge gap exists on culturally appropriate and effective prevention and cessation efforts for members of this diverse community, as limited interventions have been developed with and for this population, and there are very few studies determining the impact of these interventions. This study identifies the most salient elements of LGBTQ+ cessation and prevention interventions from the perspective of LGBTQ+ YYA. Methods Three descriptions of interventions tailored for LGBTQ+ YYA (group cessation counselling, social marketing, and a mobile phone app with social media incorporated), were shared with LGBTQ+ YYA via 24 focus groups with 204 participants in Toronto and Ottawa, Canada. Open-ended questions focused on their feelings, likes and dislikes, and concerns about the culturally modified intervention descriptions. Framework analysis was used to identify overarching themes across all three intervention descriptions. Results The data revealed eight overarching themes across all three intervention descriptions. Smoking cessation and prevention interventions should have the following key attributes: 1) be LGBTQ+ − specific; 2) be accessible in terms of location, time, availability, and cost; 3) be inclusive, relatable, and highlight diversity; 4) incorporate LGBTQ+ peer support and counselling services; 5) integrate other activities beyond smoking; 6) be positive, motivational, uplifting, and empowering; 7) provide concrete coping mechanisms; and 8) integrate rewards and incentives. Conclusions LGBTQ+ YYA focus group participants expressed a desire for an intervention that can incorporate these key elements. The mobile phone app and social media campaign were noted as potential interventions that could include all the essential elements. Electronic supplementary material The online version of this article (10.1186/s12889-018-5050-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Bruce Baskerville
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada.
| | - Katy Wong
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - Alanna Shuh
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - Aneta Abramowicz
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - Darly Dash
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
| | - Aamer Esmail
- Sherbourne Health Centre, Toronto, Ontario, Canada
| | - Ryan Kennedy
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
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Warlick C, Richter KP, Catley D, Gajewski BJ, Martin LE, Mussulman LM. Two brief valid measures of therapeutic alliance in counseling for tobacco dependence. J Subst Abuse Treat 2017; 86:60-64. [PMID: 29415852 DOI: 10.1016/j.jsat.2017.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/20/2017] [Accepted: 12/22/2017] [Indexed: 11/19/2022]
Abstract
Behavioral counseling is effective for smoking cessation and the psychotherapy literature indicates therapeutic alliance is key to counseling effectiveness. However, no tobacco-counseling specific measures of alliance exist that are suitable in most tobacco counseling contexts. This hinders assessment of counseling components in research and clinical practice. Based on the Working Alliance Inventory, and external expert review, we developed two alliance instruments: the 12-item and 3-item Working Alliance Inventory for Tobacco (WAIT-12 and WAIT-3). Two samples of 226 daily smokers via Amazon Mechanical Turk completed measures including demographics, tobacco characteristics, working alliance scales, and quit attempts. Both WAIT-12 and WAIT-3 had good to excellent internal consistency (0.92 and 0.88 for the WAIT-3 and 0.96 for the WAIT-12). The WAIT-12 1-factor model indicated poor fit (CFI=0.83, TLI=0.79, RMSEA=0.19, SRMR=0.09). The WAIT-12 3-factor model (CFI=0.94, TLI=0.93, RMSEA=0.11, SRMR=0.04) was indicative of acceptable fit. Both the WAIT-12 and the WAIT-3 were significantly associated with participants' self-reported cigarettes per day, quit attempts, and cessation. Initial validation of the WAIT-12 and WAIT-3 indicates they are psychometrically sound measures of tobacco dependence counseling alliance. The WAIT-3 provides brevity; it can be administered in under 1min. The WAIT-12 allows for assessment of specific components of therapeutic alliance. Overall, these instruments should allow for better measurement of alliance in clinical services and research.
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Affiliation(s)
- Craig Warlick
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, United States; Department of Educational Psychology, University of Kansas, 1122 W. Campus Rd. JRP Hall 621, Lawrence, KS 66045, United States.
| | - Kimber P Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, United States; University of Kansas Cancer Center, 3901 Rainbow Blvd., Kansas City, KS 66160, United States
| | - Delwyn Catley
- Department of Pediatrics, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO 64108, United States; Center for Children's Healthy Lifestyles and Nutrition Children's Mercy Hospital, 2401 Gilham Road, Kansas City, MO 64108, United States
| | - Byron J Gajewski
- University of Kansas Cancer Center, 3901 Rainbow Blvd., Kansas City, KS 66160, United States; Department of Biostatistics, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, United States
| | - Laura E Martin
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, United States; Hoglund Brain Imaging Center, University of Kansas Hospital, 3901 Rainbow Blvd., Kansas City, KS 66160, United States
| | - Laura M Mussulman
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, United States; University of Kansas Cancer Center, 3901 Rainbow Blvd., Kansas City, KS 66160, United States
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Johnson MW, Garcia-Romeu A, Johnson PS, Griffiths RR. An online survey of tobacco smoking cessation associated with naturalistic psychedelic use. J Psychopharmacol 2017; 31:841-850. [PMID: 28095732 PMCID: PMC6753943 DOI: 10.1177/0269881116684335] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Data suggest psychedelics such as psilocybin and lysergic acid diethylamide (LSD) may hold therapeutic potential in the treatment of addictions, including tobacco dependence. This retrospective cross-sectional anonymous online survey characterized 358 individuals (52 females) who reported having quit or reduced smoking after ingesting a psychedelic in a non-laboratory setting ⩾1 year ago. On average, participants smoked 14 cigarettes/day for 8 years, and had five previous quit attempts before their psychedelic experience. Of the 358 participants, 38% reported continuous smoking cessation after psychedelic use (quitters). Among quitters, 74% reported >2 years' abstinence. Of the 358 participants, 28% reported a persisting reduction in smoking (reducers), from a mode of 300 cigarettes/month before, to a mode of 1 cigarette/month after the experience. Among reducers, 62% reported >2 years of reduced smoking. Finally, 34% of the 358 participants (relapsers) reported a temporary smoking reduction before returning to baseline smoking levels, with a mode time range to relapse of 3-6 months. Relapsers rated their psychedelic experience significantly lower in personal meaning and spiritual significance than both other groups. Participants across all groups reported less severe affective withdrawal symptoms (e.g. depression, craving) after psychedelic use compared with previous quit attempts, suggesting a potential mechanism of action for psychedelic-associated smoking cessation/reduction. Changes in life priorities/values were endorsed as the most important psychological factor associated with smoking cessation/reduction. Results suggest psychedelics may hold promise in treating tobacco addiction as potentially mediated by spiritual experience, changed priorities/values, and improved emotional regulation.
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Affiliation(s)
- Matthew W. Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Roland R. Griffiths
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
Missing data are common in longitudinal observational and randomized controlled trials in smart health studies. Multiple-imputation based fuzzy clustering is an emerging non-parametric soft computing method, used for either semi-supervised or unsupervised learning. Multiple imputation (MI) has been widely-used in missing data analyses, but has not yet been scrutinized for unsupervised learning methods, although they are important for explaining the heterogeneity of treatment effects. Built upon our previous work on MIfuzzy clustering, this paper introduces the MIFuzzy concepts and performance, theoretically, empirically and numerically demonstrate how MI-based approach can reduce the uncertainty of clustering accuracy in comparison to non- and single-imputation based clustering approach. This paper advances our understanding of the utility and strength of MIFuzzy clustering approach to processing incomplete longitudinal behavioral intervention data.
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Affiliation(s)
- Hua Fang
- Department of Computer and Information Science, University of Massachusetts Dartmouth, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655
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Figueiró LR, Barros HMT, Ferigolo M, Dantas DCM. Assessment of factors related to smokers' adherence to a short-term support group for smoking cessation: a longitudinal study in a developing country. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2017; 39:19-28. [PMID: 28403319 DOI: 10.1590/2237-6089-2016-0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/12/2016] [Indexed: 11/22/2022]
Abstract
Objective: The aim of this study was to determine which individual characteristics of smokers are associated with their adherence to a support group for smoking cessation. Methods: Smokers from Porto Alegre, Brazil, were invited to participate in a support group for smoking cessation consisting of four weekly sessions. Demographic data, smoking history, presence of tobacco-related diseases, severity of nicotine dependence, stage of motivation, and symptoms of anxiety and depression were evaluated at baseline. Adherence was defined as attendance at group sessions and was measured at the second and fourth sessions of the program. Results: The study recruited 167 smokers who attended the first meeting and met criteria for admission to the study. One hundred and two of the participants returned to the second session and only 55 of those who attended the first meeting completed the four-week program. For immediate adherence (second session), adult smokers over the age of 35 were more likely to adhere to the treatment (p = 0.004), whereas smoking higher numbers of cigarettes per day was associated with lower adherence to attendance at group meetings (p = 0.031). For final adherence (fourth session), only minimal level symptoms of anxiety were associated with a higher likelihood of adherence (p = 0.02). Conclusions: Older smokers, those who smoked fewer cigarettes per day, and those with lower levels of anxiety exhibited higher rates of adherence to a smoking cessation support group.
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Affiliation(s)
| | | | - Maristela Ferigolo
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Becoña E, Martínez-Vispo C, Senra C, López-Durán A, Rodríguez-Cano R, Fernández del Río E. Cognitive-behavioral treatment with behavioral activation for smokers with depressive symptomatology: study protocol of a randomized controlled trial. BMC Psychiatry 2017; 17:134. [PMID: 28390417 PMCID: PMC5385057 DOI: 10.1186/s12888-017-1301-7] [Citation(s) in RCA: 11] [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] [Received: 03/08/2017] [Accepted: 04/03/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Smoking is an important risk factor for mental health-related problems. Numerous studies have supported a bi-directional association between cigarette smoking and depression. Despite the advances in understanding the comorbidity between both problems, the most effective psychological treatment that simultaneously targets smoking and depressive symptomatology remains unclear. The objective of this study is to assess the effectiveness of a cognitive-behavioral intervention for smoking cessation with components of behavioral activation for managing depressed mood. METHOD A single blind, three-arm, superiority randomized controlled trial is proposed. Participants will be smokers over 18 years old, who smoke at least 8 cigarettes per day. Participants will be randomized to one of three conditions, using a 2:2:1 allocation ratio: 1) standard cognitive-behavioral smoking cessation treatment; 2) standard cognitive-behavioral smoking cessation treatment plus behavioral activation; or 3) a three-month delayed treatment control group. The primary outcome measures will be biochemically verified point-prevalence abstinence (carbon monoxide in expired air) and significant change from baseline in depressive symptoms to the end of treatment, and at the 3-, 6-, and 12-month follow-up. DISCUSSION This study aims to assess the efficacy of a cognitive-behavioral intervention with behavioral activation components for smoking cessation and depressive symptoms, compared to a standard cognitive-behavioral intervention to quit smoking. As the relation between depressive symptoms, even at subclinical levels, and quitting smoking difficulties is well known, we expect that such intervention will allow obtaining higher abstinence rates, lower relapse rates, and mood improvement. TRIAL REGISTRATION ClinicalTrials.gov : NCT02844595 . Retrospectively registered 19th July, 2016. The study started in January 2016, and the recruitment is ongoing.
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Affiliation(s)
- Elisardo Becoña
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia Spain
| | - Carmela Martínez-Vispo
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia Spain
| | - Carmen Senra
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia Spain
| | - Ana López-Durán
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia Spain
| | - Rubén Rodríguez-Cano
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Galicia Spain
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Feldman C, Anderson R, Rossouw T. HIV-related pneumococcal disease prevention in adults. Expert Rev Respir Med 2017; 11:181-199. [PMID: 28228053 DOI: 10.1080/17476348.2017.1289841] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION HIV-infected persons are particularly susceptible to the development of severe pneumococcal disease, even in the setting of combination antiretroviral therapy (cART), due to slow, incomplete recovery of anti-pneumococcal host defenses. This risk is increased by avoidable aspects of lifestyle, particularly smoking, which intensify immunosuppression. Clearly, more effective preventive measures are needed to counter this threat. Areas covered: This is a detailed review of the published literature focusing on currently available strategies for prevention of pneumococcal infection in HIV-infected patients, including cotrimoxazole prophylaxis, cART, pneumococcal vaccination, and smoking cessation strategies. This is preceded by a consideration of the epidemiology, clinical presentation, risk factors, and outcome of pneumococcal disease. Expert commentary: Cotrimoxazole prophylaxis has been shown to reduce morbidity and mortality in HIV-infected patients, although there is inconsistent data on the preventive efficacy against pneumococcal infections. Some recent studies have documented unchanged incidences of IPD in adult patients in the cART era. With regard to pneumococcal vaccination, routine acceptance of the efficacy of the PCV13/PPV23 sequential administration prime-boost strategy awaits the outcome of clinical trials in those with HIV infection. Smoking cessation, and discontinuation of excessive alcohol consumption and intravenous drug abuse, are priority strategies to prevent severe pneumococcal infection.
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Affiliation(s)
- Charles Feldman
- a Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences , University of the Witwatersrand Medical School , Johannesburg , South Africa
| | - Ronald Anderson
- b Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences , University of Pretoria , Pretoria , South Africa
| | - Theresa Rossouw
- b Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences , University of Pretoria , Pretoria , South Africa
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Salisbury C, O’Cathain A, Thomas C, Edwards L, Montgomery AA, Hollinghurst S, Large S, Nicholl J, Pope C, Rogers A, Lewis G, Fahey T, Yardley L, Brownsell S, Dixon P, Drabble S, Esmonde L, Foster A, Garner K, Gaunt D, Horspool K, Man MS, Rowsell A, Segar J. An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Clare Thomas
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Louisa Edwards
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Catherine Pope
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anne Rogers
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Simon Brownsell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Padraig Dixon
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sarah Drabble
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Lisa Esmonde
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alexis Foster
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katy Garner
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kim Horspool
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mei-See Man
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alison Rowsell
- Centre for Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, UK
| | - Julia Segar
- Centre for Primary Care, University of Manchester, Manchester, UK
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Suissa K, Larivière J, Eisenberg MJ, Eberg M, Gore GC, Grad R, Joseph L, Reynier PM, Filion KB. Efficacy and Safety of Smoking Cessation Interventions in Patients With Cardiovascular Disease. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.115.002458. [DOI: 10.1161/circoutcomes.115.002458] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/21/2016] [Indexed: 11/16/2022]
Abstract
Background—
Although the efficacy and safety of smoking cessation interventions are well established, their efficacy and safety in patients with cardiovascular disease (CVD) remain unclear. The objective of this study was to evaluate the efficacy and safety of pharmacological and behavioral smoking cessation interventions in CVD patients via a meta-analysis of randomized controlled trials.
Methods and Results—
EMBASE, PsycINFO, MEDLINE, PubMed, and the Cochrane Tobacco Addiction Specialized Register were searched for randomized controlled trials evaluating the efficacy of smoking cessation pharmacotherapies and behavioral therapies in CVD patients. Outcomes of interest were smoking abstinence at 6 and 12 months, defined using the most rigorous criteria reported. Data were pooled across studies for direct comparisons using random-effects models. Network meta-analysis using a graph-theoretical approach was used to generate the indirect comparisons. Seven pharmacotherapy randomized controlled trials (n=2809) and 17 behavioral intervention randomized controlled trials (n=4666) met our inclusion criteria. Our network meta-analysis revealed that varenicline (relative risk [RR]: 2.64; 95% confidence interval [CI], 1.34–5.21) and bupropion (RR: 1.42; 95% CI, 1.01–2.01) were associated with greater abstinence than placebo. The evidence about nicotine replacement therapies was inconclusive (RR: 1.22; 95% CI, 0.72–2.06). Telephone therapy (RR: 1.47; 95% CI: 1.15–1.88) and individual counseling (RR: 1.64, 95% CI: 1.17–2.28) were both more efficacious than usual care, whereas in-hospital behavioral interventions were not (RR: 1.05; 95% CI, 0.78–1.43).
Conclusions—
Our meta-analysis suggests varenicline and bupropion, as well as individual and telephone counseling, are efficacious for smoking cessation in CVD patients.
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Affiliation(s)
- Karine Suissa
- From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General
| | - Jordan Larivière
- From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General
| | - Mark J. Eisenberg
- From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General
| | - Maria Eberg
- From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General
| | - Genevieve C. Gore
- From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General
| | - Roland Grad
- From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General
| | - Lawrence Joseph
- From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General
| | - Pauline M. Reynier
- From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General
| | - Kristian B. Filion
- From the Department of Epidemiology, Biostatistics, and Occupational Health (K.S., M.J.E., L.J., K.B.F.), Faculty of Medicine (J.L., M.J.E., K.B.F.), Division of Cardiology, Jewish General Hospital (M.J.E.), Schulich Library of Science and Engineering (G.C.G.), Department of Family Medicine (R.G.), Division of Clinical Epidemiology (L.J.), and Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada; and Center for Clinical Epidemiology, Lady Davis Institute, Jewish General
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Windle SB, Filion KB, Mancini JG, Adye-White L, Joseph L, Gore GC, Habib B, Grad R, Pilote L, Eisenberg MJ. Combination Therapies for Smoking Cessation: A Hierarchical Bayesian Meta-Analysis. Am J Prev Med 2016; 51:1060-1071. [PMID: 27617367 DOI: 10.1016/j.amepre.2016.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/17/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Treatment guidelines recommend the use of combination therapies for smoking cessation, particularly behavioral therapy (BT) as an adjunct to pharmacotherapy. However, these guidelines rely on previous reviews with important limitations. This study's objective was to evaluate the efficacy of combination therapies compared with monotherapies, using the most rigorous data available. EVIDENCE ACQUISITION A systematic review and meta-analysis of RCTs of pharmacotherapies, BTs, or both were conducted. The Cochrane Library, Embase, PsycINFO, and PubMed databases were systematically searched from inception to July 2015. Inclusion was restricted to RCTs reporting biochemically validated abstinence at 12 months. Direct and indirect comparisons were made in 2015 between therapies using hierarchical Bayesian models. EVIDENCE SYNTHESIS The search identified 123 RCTs meeting inclusion criteria (60,774 participants), and data from 115 (57,851 participants) were meta-analyzed. Varenicline with BT increased abstinence more than other combinations of a pharmacotherapy with BT (varenicline versus bupropion: OR=1.56, 95% credible interval [CrI]=1.07, 2.34; varenicline versus nicotine patch: OR=1.65, 95% CrI=1.10, 2.51; varenicline versus short-acting nicotine-replacement therapies: OR=1.68, 95% CrI=1.15, 2.53). Adding BT to any pharmacotherapy compared with pharmacotherapy alone was inconclusive, owing to wide CrIs (OR=1.17, CrI=0.60, 2.12). Nicotine patch with short-acting nicotine-replacement therapy appears safe and increases abstinence versus nicotine-replacement monotherapy (OR=1.63, CrI=1.06, 3.03). Data are limited concerning other pharmacotherapy combinations and their safety and tolerability. CONCLUSIONS Evidence suggests that combination therapy benefits may be less than previously thought. Combined with BT, varenicline increases abstinence more than other pharmacotherapy with BT combinations.
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Affiliation(s)
- Sarah B Windle
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Kristian B Filion
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Joseph G Mancini
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Lauren Adye-White
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Lawrence Joseph
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada; Research Institute, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Genevieve C Gore
- Schulich Library of Science and Engineering, McGill University, Montreal, Quebec, Canada
| | - Bettina Habib
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Roland Grad
- Herzl Family Practice Centre, Jewish General Hospital, Montreal, Quebec, Canada; Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Louise Pilote
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada; Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Cardiology, Jewish General Hospital, Montreal, Quebec, Canada.
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[Psychotherapy and pharmacotherapy for harmful tobacco use and tobacco dependency]. DER NERVENARZT 2016; 87:35-45. [PMID: 26666768 DOI: 10.1007/s00115-015-0037-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.
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Williams JM, Steinberg ML, Kenefake AN, Burke MV. An Argument for Change in Tobacco Treatment Options Guided by the ASAM Criteria for Patient Placement. J Addict Med 2016; 10:291-9. [PMID: 27466070 PMCID: PMC5049967 DOI: 10.1097/adm.0000000000000239] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 06/02/2016] [Indexed: 11/26/2022]
Abstract
Tobacco use is a major threat to public health in the United States, and the number one cause of preventable death. Although most smokers try to quit unaided, robust data indicate that pairing behavioral support to US Food Drug Administration-approved cessation medications significantly increase cessation rates. Those who do receive assistance in quitting usually receive very low intensity treatment, regardless of the severity of their dependence or their medical and environmental circumstances. This is in stark contrast to how other substance use disorders are treated, where there are varying levels of care depending on addiction severity and biopsychosocial circumstances. The American Society of Addiction Medicine (ASAM) developed a formal algorithm for assessing substance use disorders and determining the optimal level of care. The ASAM Patient Placement Criteria are regularly used to determine the appropriate level of care for all substance use disorders except tobacco. This paper will review key aspects of the ASAM dimensions of care and placement levels, with emphasis on how they apply to tobacco use and present case examples of typical smokers who would benefit from a higher intensity of tobacco dependence treatment. We also present current barriers to reimbursing healthcare providers for these services. We conclude with a commentary and discussion regarding recommendations for improvements in tobacco dependence treatment care.
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Affiliation(s)
- Jill M Williams
- Rutgers Robert Wood Johnson Medical School (JMW, MLS, ANK), New Brunswick, NJ; and Mayo Medical Center, Rochester, MN (MVB)
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40
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Wilson SM, Hair LP, Hertzberg JS, Kirby AC, Olsen MK, Lindquist JH, Maciejewski ML, Beckham JC, Calhoun PS. Abstinence Reinforcement Therapy (ART) for rural veterans: Methodology for an mHealth smoking cessation intervention. Contemp Clin Trials 2016; 50:157-65. [PMID: 27521811 DOI: 10.1016/j.cct.2016.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/05/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Smoking is the most preventable cause of morbidity and mortality in U.S. veterans. Rural veterans in particular have elevated risk for smoking and smoking-related illness. However, these veterans underutilize smoking cessation treatment, which suggests that interventions for rural veterans should optimize efficacy and reach. OBJECTIVE The primary goal of the current study is to evaluate the effectiveness of an intervention that combines evidenced based treatment for smoking cessation with smart-phone based, portable contingency management on smoking rates compared to a contact control intervention in a randomized controlled trial among rural Veteran smokers. Specifically, Veterans will be randomized to receive Abstinence Reinforcement Therapy (ART) which combines evidenced based cognitive-behavioral telephone counseling (TC), a tele-medicine clinic for access to nicotine replacement (NRT), and mobile contingency management (mCM) or a control condition (i.e., TC and NRT alone) that will provide controls for therapist, medication, time and attention effects. METHODS Smokers were identified using VHA electronic medical records and recruited proactively via telephone. Participants (N=310) are randomized to either ART or a best practice control consisting of telephone counseling and telemedicine. Participating patients will be surveyed at 3-months, 6-months and 12-months post-randomization. The primary outcome measure is self-reported and biochemically validated prolonged abstinence at 6-month follow-up. DISCUSSION This trial is designed to test the relative effectiveness of ART compared to a telehealth-only comparison group. Dissemination of this mHealth intervention for veterans in a variety of settings would be warranted if ART improves smoking outcomes for rural veterans and is cost-effective.
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Affiliation(s)
- Sarah M Wilson
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States.
| | - Lauren P Hair
- Durham VA Medical Center, Durham, NC 27705, United States
| | | | - Angela C Kirby
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States
| | - Maren K Olsen
- Center for Health Services Research in Primary Care, 508 Fulton Street, Durham, NC 27705, United States
| | - Jennifer H Lindquist
- Center for Health Services Research in Primary Care, 508 Fulton Street, Durham, NC 27705, United States
| | - Matthew L Maciejewski
- Center for Health Services Research in Primary Care, 508 Fulton Street, Durham, NC 27705, United States
| | - Jean C Beckham
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - Patrick S Calhoun
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States; Center for Health Services Research in Primary Care, 508 Fulton Street, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
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41
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Johnson MW, Garcia-Romeu A, Griffiths RR. Long-term follow-up of psilocybin-facilitated smoking cessation. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:55-60. [PMID: 27441452 DOI: 10.3109/00952990.2016.1170135] [Citation(s) in RCA: 311] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A recent open-label pilot study (N = 15) found that two to three moderate to high doses (20 and 30 mg/70 kg) of the serotonin 2A receptor agonist, psilocybin, in combination with cognitive behavioral therapy (CBT) for smoking cessation, resulted in substantially higher 6-month smoking abstinence rates than are typically observed with other medications or CBT alone. OBJECTIVES To assess long-term effects of a psilocybin-facilitated smoking cessation program at ≥12 months after psilocybin administration. METHODS The present report describes biologically verified smoking abstinence outcomes of the previous pilot study at ≥12 months, and related data on subjective effects of psilocybin. RESULTS All 15 participants completed a 12-month follow-up, and 12 (80%) returned for a long-term (≥16 months) follow-up, with a mean interval of 30 months (range = 16-57 months) between target-quit date (i.e., first psilocybin session) and long-term follow-up. At 12-month follow-up, 10 participants (67%) were confirmed as smoking abstinent. At long-term follow-up, nine participants (60%) were confirmed as smoking abstinent. At 12-month follow-up 13 participants (86.7%) rated their psilocybin experiences among the five most personally meaningful and spiritually significant experiences of their lives. CONCLUSION These results suggest that in the context of a structured treatment program, psilocybin holds considerable promise in promoting long-term smoking abstinence. The present study adds to recent and historical evidence suggesting high success rates when using classic psychedelics in the treatment of addiction. Further research investigating psilocybin-facilitated treatment of substance use disorders is warranted.
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Affiliation(s)
- Matthew W Johnson
- a Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Albert Garcia-Romeu
- a Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Roland R Griffiths
- a Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,b Department of Neuroscience , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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42
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Dobbie F, Hiscock R, Leonardi-Bee J, Murray S, Shahab L, Aveyard P, Coleman T, McEwen A, McRobbie H, Purves R, Bauld L. Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study. Health Technol Assess 2016; 19:1-156. [PMID: 26565129 DOI: 10.3310/hta19950] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND NHS Stop Smoking Services (SSSs) provide free at the point of use treatment for smokers who would like to stop. Since their inception in 1999 they have evolved to offer a variety of support options. Given the changes that have happened in the provision of services and the ongoing need for evidence on effectiveness, the Evaluating Long-term Outcomes for NHS Stop Smoking Services (ELONS) study was commissioned. OBJECTIVES The main aim of the study was to explore the factors that determine longer-term abstinence from smoking following intervention by SSSs. There were also a number of additional objectives. DESIGN The ELONS study was an observational study with two main stages: secondary analysis of routine data collected by SSSs and a prospective cohort study of service clients. The prospective study had additional elements on client satisfaction, well-being and longer-term nicotine replacement therapy (NRT) use. SETTING The setting for the study was SSSs in England. For the secondary analysis, routine data from 49 services were obtained. For the prospective study and its added elements, nine services were involved. The target population was clients of these services. PARTICIPANTS There were 202,804 cases included in secondary analysis and 3075 in the prospective study. INTERVENTIONS A combination of behavioural support and stop smoking medication delivered by SSS practitioners. MAIN OUTCOME MEASURES Abstinence from smoking at 4 and 52 weeks after setting a quit date, validated by a carbon monoxide (CO) breath test. RESULTS Just over 4 in 10 smokers (41%) recruited to the prospective study were biochemically validated as abstinent from smoking at 4 weeks (which was broadly comparable with findings from the secondary analysis of routine service data, where self-reported 4-week quit rates were 48%, falling to 34% when biochemical validation had occurred). At the 1-year follow-up, 8% of prospective study clients were CO validated as abstinent from smoking. Clients who received specialist one-to-one behavioural support were twice as likely to have remained abstinent than those who were seen by a general practitioner (GP) practice and pharmacy providers [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2 to 4.6]. Clients who received group behavioural support (either closed or rolling groups) were three times more likely to stop smoking than those who were seen by a GP practice or pharmacy providers (OR 3.4, 95% CI 1.7 to 6.7). Satisfaction with services was high and well-being at baseline was found to be a predictor of abstinence from smoking at longer-term follow-up. Continued use of NRT at 1 year was rare, but no evidence of harm from longer-term use was identified from the data collected. CONCLUSIONS Stop Smoking Services in England are effective in helping smokers to move away from tobacco use. Using the 52-week CO-validated quit rate of 8% found in this study, we estimate that in the year 2012-13 the services supported 36,249 clients to become non-smokers for the remainder of their lives. This is a substantial figure and provides one indicator of the ongoing value of the treatment that the services provide. The study raises a number of issues for future research including (1) examining the role of electronic cigarettes (e-cigarettes) in smoking cessation for service clients [this study did not look at e-cigarette use (except briefly in the longer-term NRT study) but this is a priority for future studies]; (2) more detailed comparisons of rolling groups with other forms of behavioural support; (3) further exploration of the role of practitioner knowledge, skills and use of effective behaviour change techniques in supporting service clients to stop smoking; (4) surveillance of the impact of structural and funding changes on the future development and sustainability of SSSs; and (5) more detailed analysis of well-being over time between those who successfully stop smoking and those who relapse. Further research on longer-term use of non-combustible nicotine products that measures a wider array of biomarkers of smoking-related harm such as lung function tests or carcinogen metabolites. FUNDING The National Institute for Health Research Health Technology Assessment programme. The UK Centre for Tobacco and Alcohol Studies provided funding for the longer-term NRT study.
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Affiliation(s)
- Fiona Dobbie
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, UK
| | - Rosemary Hiscock
- UK Centre for Tobacco and Alcohol Studies, UK.,Department for Health, University of Bath, Bath, UK
| | - Jo Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Susan Murray
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, UK
| | - Lion Shahab
- UK Centre for Tobacco and Alcohol Studies, UK.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Paul Aveyard
- UK Centre for Tobacco and Alcohol Studies, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tim Coleman
- UK Centre for Tobacco and Alcohol Studies, UK.,Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies, UK.,National Centre for Smoking Cessation and Training, London, UK
| | - Hayden McRobbie
- UK Centre for Tobacco and Alcohol Studies, UK.,Wolfson Institute of Preventative Medicine, Queen Mary University of London, London, UK
| | - Richard Purves
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,Department for Health, University of Bath, Bath, UK
| | - Linda Bauld
- Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, UK.,UK Centre for Tobacco and Alcohol Studies, UK
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Zhang Z, Fang H. Multiple- vs Non- or Single-Imputation based Fuzzy Clustering for Incomplete Longitudinal Behavioral Intervention Data. ...IEEE...INTERNATIONAL CONFERENCE ON CONNECTED HEALTH: APPLICATIONS, SYSTEMS AND ENGINEERING TECHNOLOGIES. IEEE INTERNATIONAL CONFERENCE ON CONNECTED HEALTH: APPLICATIONS, SYSTEMS AND ENGINEERING TECHNOLOGIES 2016; 2016:219-228. [PMID: 29034067 PMCID: PMC5635859 DOI: 10.1109/chase.2016.19] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Disentangling patients' behavioral variations is a critical step for better understanding an intervention's effects on individual outcomes. Missing data commonly exist in longitudinal behavioral intervention studies. Multiple imputation (MI) has been well studied for missing data analyses in the statistical field, however, has not yet been scrutinized for clustering or unsupervised learning, which are important techniques for explaining the heterogeneity of treatment effects. Built upon previous work on MI fuzzy clustering, this paper theoretically, empirically and numerically demonstrate how MI-based approach can reduce the uncertainty of clustering accuracy in comparison to non-and single-imputation based clustering approach. This paper advances our understanding of the utility and strength of multiple-imputation (MI) based fuzzy clustering approach to processing incomplete longitudinal behavioral intervention data.
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Affiliation(s)
- Zhaoyang Zhang
- Division of Biostatistics and Health Services Research, Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA 01655
| | - Hua Fang
- Division of Biostatistics and Health Services Research, Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA 01655
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44
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Ledgerwood DM, Yskes R. Smoking Cessation for People Living With HIV/AIDS: A Literature Review and Synthesis. Nicotine Tob Res 2016; 18:2177-2184. [PMID: 27245237 DOI: 10.1093/ntr/ntw126] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/22/2016] [Indexed: 01/26/2023]
Abstract
INTRODUCTION People living with HIV/AIDS (PLWHA) are more likely to smoke cigarettes than are individuals in the general population. The health implications of tobacco use are substantially more dire among PLWHA than among otherwise healthy smokers, including higher rates of various cancers, cardiovascular disease, inflammation, and lung infections. Efficacious behavioral and medication treatments for treating nicotine dependence have rarely been investigated in PLWHA. METHODS We present a review of studies examining the efficacy of smoking cessation interventions. RESULTS AND CONCLUSIONS The literature reveals some limited evidence for the efficacy of behavioral interventions. However, the research literature on these interventions is sparse and the efficacy findings are mixed. Studies exploring the use of mobile technologies for reducing treatment barriers are becoming more prevalent. Few published trials have directly examined the efficacy of pharmacological smoking cessation interventions among PLWHA. Specific gaps in the treatment literature are discussed in detail, and a strategy is presented for developing a greater understanding of factors that contribute to the efficacy of smoking cessation among PLWHA. IMPLICATIONS This paper provides the most comprehensive review to date on smoking cessation intervention research conducted with PLWHA. It also discusses specific gaps in the literature that should be a priority for future research.
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Affiliation(s)
- David M Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
| | - Russell Yskes
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
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Giovancarli C, Malbos E, Baumstarck K, Parola N, Pélissier MF, Lançon C, Auquier P, Boyer L. Virtual reality cue exposure for the relapse prevention of tobacco consumption: a study protocol for a randomized controlled trial. Trials 2016; 17:96. [PMID: 26892001 PMCID: PMC4759851 DOI: 10.1186/s13063-016-1224-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 02/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Successful interventions have been developed for smoking cessation, but the success of smoking relapse prevention interventions has been limited. In particular, cognitive behavioural therapy (CBT) has been hampered by a high relapse rate. Because relapses can be due to the presence of conditions associated with tobacco consumption (such as drinking in bars with friends), virtual reality exposure therapy (VRET) can generate synthetic environments that represent risk situations for the patient in the context of relapse prevention. The primary objective of this study is to evaluate the effectiveness of CBT coupled with VRET, in comparison to CBT alone, in the prevention of smoking relapse. The secondary objectives are to assess the impact of CBT coupled with VRET on anxiety, depression, quality of life, self-esteem and addictive comorbidities (such as alcohol, cannabis, and gambling). A third objective examines the feasibility and acceptability of VR use considering elements such as presence, cybersickness and number of patients who complete the VRET program. Method/design The present study is a 14-month (2 months of therapy followed by 12 months of follow-up), prospective, comparative, randomized and open clinical trial, involving two parallel groups (CBT coupled with VRET versus CBT alone). The primary outcome is the proportion of individuals with tobacco abstinence at 6 months after the end of the therapy. Abstinence is defined by the total absence of tobacco consumption assessed during a post-test interview and with an apparatus that measures the carbon monoxide levels expired. A total of 60 individuals per group will be included. Discussion This study is the first to examine the efficacy of CBT coupled with VRET in the prevention of smoking relapse. Because VRET is simple to use and has a low cost, this interactive therapeutic method might be easily implemented in clinical practice if the study confirms its efficacy. Trial registration ClinicalTrials.gov Identifier: NCT02205060 (registered 25 July 2014). Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1224-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Camille Giovancarli
- Department of Psychiatry, La Conception University Hospital, 13005, Marseille, France.
| | - Eric Malbos
- Department of Psychiatry, La Conception University Hospital, 13005, Marseille, France.
| | - Karine Baumstarck
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France.
| | - Nathalie Parola
- Department of Psychiatry, La Conception University Hospital, 13005, Marseille, France
| | | | - Christophe Lançon
- Department of Psychiatry, La Conception University Hospital, 13005, Marseille, France. .,Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France.
| | - Pascal Auquier
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France.
| | - Laurent Boyer
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, 13005, Marseille, France.
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Are Single-session Smoking Cessation Groups a Feasible Option for Rural Australia? – Outcomes From a Pilot Study. J Smok Cessat 2015. [DOI: 10.1017/jsc.2014.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Single-session group smoking cessation interventions have received little attention in the literature.Aims: This study aimed to test the feasibility and outcomes of a single-session large group smoking cessation intervention in a rural area of New South Wales.Methods: Participants from a smoking cessation course (N = 42) were asked about cigarette consumption, quit attempts, and readiness and confidence to quit at registration and six months. The two-hour intervention occurred in a group setting and comprised of cognitive behaviour therapy and pharmacotherapy advice.Results: The analysis revealed a 26.2% (N = 11) quit rate based on self-report and/or carbon monoxide validation at 6 months (intention to treat). Those who quit all used pharmacotherapy: eight (73%) Nicotine Replacement Therapy (NRT); two (18%) varenicline and one (9%) bupropion with NRT. Seven people (17%) used medicines to reduce consumption of cigarettes. A paired samples t test of those still smoking showed a statistically significant decrease in the numbers of cigarettes smoked per day (p<.001).Conclusion: The quit rate of 26.2% from this large single-session smoking cessation course is comparable to that expected from groups having multiple sessions. As a pilot study, these data suggest that a multi-faceted single-session two-hour smoking cessation intervention can successfully support quit attempts in a rural location.
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Patnode CD, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force. Ann Intern Med 2015; 163:608-21. [PMID: 26389650 DOI: 10.7326/m15-0171] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tobacco use is the leading cause of preventable death in the United States. PURPOSE To review the effectiveness and safety of pharmacotherapy and behavioral interventions for tobacco cessation. DATA SOURCES 5 databases and 8 organizational Web sites were searched through 1 August 2014 for systematic reviews, and PubMed was searched through 1 March 2015 for trials on electronic nicotine delivery systems. STUDY SELECTION Two reviewers examined 114 articles to identify English-language reviews that reported health, cessation, or adverse outcomes. DATA EXTRACTION One reviewer abstracted data from good- and fair-quality reviews, and a second checked for accuracy. DATA SYNTHESIS 54 reviews were included. Behavioral interventions increased smoking cessation at 6 months or more (physician advice had a pooled risk ratio [RR] of 1.76 [95% CI, 1.58 to 1.96]). Nicotine replacement therapy (RR, 1.60 [CI, 1.53 to 1.68]), bupropion (RR, 1.62 [CI, 1.49 to 1.76]), and varenicline (RR, 2.27 [CI, 2.02 to 2.55]) were also effective for smoking cessation. Combined behavioral and pharmacotherapy interventions increased cessation by 82% compared with minimal intervention or usual care (RR, 1.82 [CI, 1.66 to 2.00]). None of the drugs were associated with major cardiovascular adverse events. Only 2 trials addressed efficacy of electronic cigarettes for smoking cessation and found no benefit. Among pregnant women, behavioral interventions benefited cessation and perinatal health; effects of nicotine replacement therapy were not significant. LIMITATION Evidence published after each review's last search date was not included. CONCLUSION Behavioral and pharmacotherapy interventions improve rates of smoking cessation among the general adult population, alone or in combination. Data on the effectiveness and safety of electronic nicotine delivery systems are limited. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Carrie D. Patnode
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jillian T. Henderson
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jamie H. Thompson
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Caitlyn A. Senger
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Stephen P. Fortmann
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Evelyn P. Whitlock
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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Cherrington A, Williams JH, Foster PP, Coley HL, Kohler C, Allison JJ, Kiefe CI, Volkman JE, Houston TK. Narratives to enhance smoking cessation interventions among African-American smokers, the ACCE project. BMC Res Notes 2015; 8:567. [PMID: 26467316 PMCID: PMC4606962 DOI: 10.1186/s13104-015-1513-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low-income, African-American smokers are less likely to have resources to aid in quitting smoking. Narrative communication may provide an enhancement to traditional smoking cessation interventions like NRT, medications, or behavioral treatments for this audience. After extensive pilot testing of stories and personal experiences with smoking cessation from African-Americans from a low-income community, we conducted a randomized control trial using stories to augment routine inpatient treatment among African-Americans at an urban Southern hospital (N = 300). RESULTS Differences in smoking cessation outcomes between the intervention (stories DVD + routine clinical treatment) and control (routine clinical treatment) arms were compared using self-report and carbon monoxide measurement at 6-months. Compared to control, individuals who viewed the intervention stories DVD reported greater intentions to quit. Although continuous quitting marginally favored the intervention, our main result did not reach statistical significance (p = 0.16). CONCLUSION Narrative communication via storytelling to promote smoking cessation among African-Americans in the South is one method to communicate smoking cessation. Results suggest this may not be sufficient as a stand-alone augmentation of routine clinical treatment for continuous smoking cessation. Smoking cessation efforts need to continually assess different means of communicating to smokers about quitting. CLINICAL TRIALS REGISTRATION The ClinicalTrials.gov Identifier is NCT00101491. This trial was registered January 10, 2005.
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Affiliation(s)
- Andrea Cherrington
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jessica H Williams
- Department of General Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Pamela Payne Foster
- Rural Health Institute for Clinical and Translational Science, University of Alabama School of Medicine, Tuscaloosa Campus, Tuscaloosa, AL, USA.
- Department of Community and Rural Medicine, University of Alabama School of Medicine, Tuscaloosa Campus, Tuscaloosa, AL, USA.
| | - Heather L Coley
- Department of General Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Connie Kohler
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Jeroan J Allison
- Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Catarina I Kiefe
- Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Julie E Volkman
- Center for Health Quality, Outcomes and Economic Research (CHQOER), Bedford, MA, USA.
- e-Health Quality Enhancement Research Initiative (QUERI) Center, Bedford VAMC, Bedford, MA, USA.
| | - Thomas K Houston
- Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
- Center for Health Quality, Outcomes and Economic Research (CHQOER), Bedford, MA, USA.
- e-Health Quality Enhancement Research Initiative (QUERI) Center, Bedford VAMC, Bedford, MA, USA.
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA.
- Department of Veterans Affairs, ENRM Veterans Hospital, 200 Springs Rd., Bedford, MA, 01730, USA.
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Chandrashekar M, Sattar FA, Bondade S, Kumar KK. A comparative study of different modalities of treatment in nicotine dependence syndrome. Asian J Psychiatr 2015; 17:29-35. [PMID: 26293443 DOI: 10.1016/j.ajp.2015.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 06/28/2015] [Accepted: 07/11/2015] [Indexed: 11/30/2022]
Abstract
UNLABELLED There are different modalities for management of Nicotine dependence, but it is still inconclusive which is the best modality for the treatment of Nicotine dependence syndrome (NDS). In this background the present study was carried out to assess the efficacy and to compare different modalities for the treatment of NDS. METHODS Patients diagnosed as NDS as per ICD-10 were taken up for study. These patients were administered proforma to elicit sociodemographic details, Fagerstrom test for Nicotine Dependence, Questionnaire of Smoking Urges-Brief and breath analysis was done using carbon monoxide meter. Assessment was done at base line and at weekly follow-ups for 12 weeks. Patients were divided into six groups randomly. Group A received BUP at a dose of 150mg/day for 3 days; subsequently increased to 300mg/day, Group B: for initial 6 weeks Nicotine gum of 4mg every 1-2 hourly was used and next 6 weeks every 2-4 hourly was used, Group C: BI, Group D: BI+BUP, Group E: BI+NRT, Group F received BUP+NRT+BI. RESULTS The quit rates at end of the study were BUP-30%, NRT-26.66%, BI-23.33%, BI+BUP-43.33%, BI+NRT-33.33%, and BI+BUP+NRT-50%. BI+BUP+NRT had 2-3 times more quit rates than the individual modality treatment group. CONCLUSION There was no statistically significant difference between the study groups, but there was clinical difference in quit rates. Among the groups BI+BUP+NRT had higher quit rates compared to other groups. Combination modalities yield better quit rates than individual modalities.
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Affiliation(s)
- M Chandrashekar
- Department of Psychiatry, V.I.M.S&R.C, EPIP Area, Whitefield, Bangalore 560066, Karnataka, India.
| | - F A Sattar
- Department of Psychiatry, V.I.M.S&R.C, EPIP Area, Whitefield, Bangalore 560066, Karnataka, India.
| | - S Bondade
- Department of Psychiatry, V.I.M.S&R.C, EPIP Area, Whitefield, Bangalore 560066, Karnataka, India.
| | - K Kiran Kumar
- Department of Psychiatry, V.I.M.S&R.C, EPIP Area, Whitefield, Bangalore 560066, Karnataka, India.
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Wu L, Sun S, He Y, Zeng J. Effect of Smoking Reduction Therapy on Smoking Cessation for Smokers without an Intention to Quit: An Updated Systematic Review and Meta-Analysis of Randomized Controlled. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10235-53. [PMID: 26308034 PMCID: PMC4586609 DOI: 10.3390/ijerph120910235] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Effective strategies are needed to encourage smoking cessation for smokers without an intention to quit. We systematically reviewed the literature to investigate whether smoking reduction therapy can increase the long-term cessation rates of smokers without an intention to quit. METHODS PubMed, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched for randomized controlled trials (RCTs) on the effect of smoking reduction therapy on long-term smoking cessation in smokers without an intention to quit. The primary outcome was the cessation rate at the longest follow-up period. A random effects model was used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs). RESULTS Fourteen trials with a total of 7981 smokers were included. The pooled analysis suggested that reduction support plus medication significantly increased the long-term cessation of smokers without an intention to quit compared to reduction support plus placebo (RR, 1.97; 95% CI, 1.44-2.7; I(2), 52%) or no intervention (RR, 1.93; 95% CI, 1.41-2.64; I(2), 46%). In a subgroup of smokers who received varenicline or nicotine replacement therapy (NRT), the differences were also statistically significant. This suggests the safety of using NRT. The percentage of smokers with serious adverse events who discontinued because of these events in the non-NRT group was slightly significantly different than in the control group. Insufficient evidence is available to test the efficacy of reduction behavioural support in promoting long-term cessation among this population. CONCLUSIONS The present meta-analysis indicated the efficacy of NRT- and varenicline-assisted reduction to achieve complete cessation among smokers without an intention to quit. Further evidence is needed to assess the efficacy and safety of reduction behavioural support and bupropion.
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Affiliation(s)
- Lei Wu
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
| | - Samio Sun
- Department of Bioengineering, The University of Tokyo, 1138656, Japan.
| | - Yao He
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
- State Key Laboratory of Kidney Disease, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
| | - Jing Zeng
- Department of Epidemiology, Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
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