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Ruiz RA, Lehavot K, Heffner JL, Kava CM, Ornelas IJ. Cigarette Smoking Motives and Stages of Change in Smoking Cessation Among Veterans: Differences by Gender and Sexual Orientation. Am J Health Promot 2024; 38:339-348. [PMID: 37643248 PMCID: PMC10902186 DOI: 10.1177/08901171231197147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE To examine differences across gender and sexual orientation in cigarette smoking motives and stages of change in smoking cessation among Veterans. DESIGN Secondary data analysis of cross-sectional baseline surveys from a prospective cohort study. SETTING United States, self-administered online survey. PARTICIPANTS Cisgender Veterans who reported past-year smoking (N = 146); 66.4% identified as lesbian, gay, or bisexual and 52.1% were men. MEASURES Smoking motives (i.e., social, self-confidence, boredom relief, and affect regulation), with higher scores indicating stronger motivation to smoke. Stages of change categories included precontemplation, contemplation/preparation, and action/maintenance. ANALYSIS Analyses were stratified by gender and sexual orientation. Age-adjusted linear regression models estimated differences in smoking motives scores and multinomial logistic regression models estimated differences in stages of change categories relative to the precontemplation stage (reference category). RESULTS In this Veteran sample, gay men reported higher social smoking motives vs heterosexual men (β = 1.50 (95% CI: .04, 2.97), P-value = .045) and higher boredom relief smoking motives vs bisexual men (β = 1.53 (95% CI: .06, 2.29), P-value = .041) in age-adjusted models. Lesbian women were more likely to be in the action/maintenance stage relative to the precontemplation stage when compared to both heterosexual women (aRRR = 4.88 (95% CI: 1.00, 23.79) P-value = .050) and bisexual women (aRRR = 16.46 (95% CI: 2.12, 127.57), P-value = .007) after adjusting for age. CONCLUSION Smoking cessation interventions may benefit from enhancing peer support for gay men. Given bisexual and heterosexual women were in less advance stages of change, there may be a greater need for motivational interventions to encourage quitting and additional support to assist with cessation efforts. Overall, findings highlight the diversity of cigarette use within LGB communities.
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Affiliation(s)
- Raymond A. Ruiz
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Keren Lehavot
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Jaimee L. Heffner
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Christine M. Kava
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - India J. Ornelas
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Su Z, Wei X, Cheng A, Zhou X, Li J, Qin R, Liu Y, Xia X, Song Q, Liu Z, Zhao L, Xiao D, Wang C. Real-world utilization and effectiveness of Message-Based Tobacco Cessation Program (mCessation) in Chinese general population (Preprint). J Med Internet Res 2022; 25:e44840. [PMID: 37129934 DOI: 10.2196/44840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/25/2023] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Randomized controlled trials on text message interventions for smoking cessation have shown they are effective and recommended for tobacco control. However, the effectiveness in real-world settings is largely unknown, especially in low- and middle-income countries. OBJECTIVE This study aimed to provide real-world evidence about the utilization and effectiveness of a message-based tobacco cessation program (mCessation) in China. METHODS From May 2021 to September 2022, 16,746 people from the general population participated in the mCessation program provided by the World Health Organization. All participants received text messages on smoking cessation via instant messaging for 6 months, and they were also required to report smoking status. We randomly selected 2500 participants and interviewed them by telephone to determine the 7-day point prevalence abstinence rate at 6 months. Descriptive statistics were used to analyze population characteristics and abstinence rate. Logistic regression analysis was performed to explore risk factors for the abstinence rate. RESULTS Among the 2500 participants, the mean age was 35 years, and most (2407/2500, 96.20%) were male. The prevalence of tobacco dependence and light degree of tobacco dependence were 85.70% (2142/2500) and 89.10% (2228/2500), respectively. For respondents (953/2500, 38.10%), the 7-day point prevalence abstinence rate at 6 months was 21.90% (209/953). Participants older than 40 years or with tobacco dependence had significantly higher abstinence rates than those who were younger than 30 years old (odds ratio [OR] 1.77, 95% CI 1.06-3.29) or without dependence (OR 1.64, 95% CI 1.08-2.51), respectively. However, married people or heavily dependent smokers tended to find it more difficult to successfully quit smoking compared with unmarried people (OR 0.57, 95% CI 0.34-0.93) or lightly dependent smokers (OR 0.16, 95% CI 0.02-0.98), respectively. CONCLUSIONS In a real-world setting, mCessation China was generally acceptable to men and lightly dependent smokers, and it could help 1 in 5 smokers aged 18 years to 67 years quit smoking. However, strategies to increase awareness of young and married adults may improve implementation and abstinence rates.
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Affiliation(s)
- Zheng Su
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaowen Wei
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Capital Medical University, China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Anqi Cheng
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinmei Zhou
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinxuan Li
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Capital Medical University, China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Rui Qin
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Liu
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Xia
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingqing Song
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Capital Medical University, China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Zhao Liu
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Liang Zhao
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dan Xiao
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Wang
- Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, Beijing, China
- World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Graham AL, Papandonatos GD, Cha S, Amato MS, Jacobs MA, Cohn AM, Abroms LC, Whittaker R. Effectiveness of an optimized text message and Internet intervention for smoking cessation: A randomized controlled trial. Addiction 2022; 117:1035-1046. [PMID: 34472676 PMCID: PMC9293135 DOI: 10.1111/add.15677] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023]
Abstract
AIMS To evaluate the effectiveness of a combined internet and text message intervention for smoking cessation compared with an internet intervention alone. The text message intervention was optimized for engagement in an earlier multiphase optimization (MOST) screening phase. DESIGN A parallel, two-group, individually randomized clinical trial (RCT) was conducted in a MOST confirming phase. Recruitment spanned December 2018 to March 2019. Follow-up was conducted at 3 and 9 months, beginning March 2019 and ending January 2020. SETTING United States: a digital study conducted among new registrants on a free tobacco cessation website. PARTICIPANTS Eligible individuals were 618 adult current smokers in the United States, age 18 years or older who signed up for text messages during website registration (67.2% female, 70.4% white). INTERVENTIONS The treatment arm (WEB+TXT; n = 311) received access to the website and text messaging. The control arm (WEB; n = 307) received access to the website alone. MEASUREMENTS The primary outcome was self-reported 30-day point prevalence abstinence (ppa) at 9 months post-randomization analyzed under intent to treat (ITT), counting non-responders as smoking. Secondary outcomes included 3-month measures of 30-day ppa, intervention engagement and intervention satisfaction. FINDINGS Abstinence rates at 9 months were 23.1% among WEB+TXT and 23.2% among WEB (OR = 1.00, 95% CI = 0.69-1.45; P = 0.99). WEB+TXT increased engagement with 5 of 6 interactive features (standardized mean difference (SMD) = 0.26-0.47, all P < 0.001) and repeat website visits (48.7% vs 38.9%, SMD = 0.14, P = 0.02). Satisfaction metrics favored WEB+TXT (satisfied: 96.3% vs 90.5%, SMD = 0.17, P = 0.008; recommend to friend: 95.9% vs 90.1%, SMD = 0.16, P = 0.028). CONCLUSIONS A randomized controlled trial found no evidence that a combined internet and text message intervention for smoking cessation compared with an internet intervention alone increased 9-month abstinence rates among adult current smokers in the United States, despite evidence of higher levels of intervention engagement and satisfaction at 3 months.
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Affiliation(s)
- Amanda L. Graham
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Sarah Cha
- Innovations Center, Truth InitiativeWashingtonDCUSA
| | - Michael S. Amato
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Amy M. Cohn
- Health Promotion Research CenterUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA,Department of Pediatrics, Children's HospitalUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public HealthThe George Washington UniversityWashingtonDCUSA
| | - Robyn Whittaker
- National Institute for Health InnovationUniversity of AucklandAucklandNew Zealand
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Christofferson DE, Blalock DV, Knoeppel J, Beckham JC, Hamlett-Berry K, Hertzberg JS. A real-world evaluation of a smokeless tobacco cessation text message program for veterans: Outcomes and comparison to cigarette smokers. Nicotine Tob Res 2021; 24:186-195. [PMID: 34545940 DOI: 10.1093/ntr/ntab191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/17/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smokeless tobacco (ST) use and cessation rates have remained unchanged while cigarette smoking has declined, and cessation rates have increased. Text message programs have proved effective for cigarette smokers but have not been evaluated for ST users. The Veterans Health Administration (VHA) created a ST-specific arm of its SmokefreeVET automated text message program to help veteran ST users quit. METHODS A retrospective evaluation was conducted on a real-world sample of veteran ST users (n=1,139) who subscribed to SmokefreeVET between 2017 and 2020. Time in program, abstinence, and nicotine replacement therapy (NRT) use were evaluated and compared to 9,764 cigarette smokers who subscribed to SmokefreeVET. RESULTS Younger subscribers were more likely to opt out early; 54% of ST users and 60% of cigarette smokers completed the 6-week program. ST users were more likely to report abstinence than cigarette smokers at all time points: the primary outcome, 30-day abstinence at 6 months, was 3.9% in ST users and 2.6% in cigarette smokers (p=.05) and the secondary outcome, abstinence at 3 months, was 5.3% in ST users and 3.4% in cigarette smokers (p=.03). NRT was used by 17% of ST users and was associated with a trend toward higher abstinence compared to ST users who did not use NRT. CONCLUSION A real-world sample of ST users were more likely to report abstinence after using the SmokefreeVET text program than cigarette smokers. Automated text message programs may be effective for increasing cessation among ST users and warrant further investigation. IMPLICATIONS Smokeless tobacco (ST) cessation is an important public health priority and of importance for veteran and military populations that have higher rates of ST use. There have been relatively few studies conducted investigating the effectiveness of text message interventions for ST cessation, despite the proven efficacy for cigarette smokers. This study provides evidence from a large, real-world sample that text message programs may be effective for ST users and suggests that further research into this treatment modality for ST users is needed.
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Affiliation(s)
- Dana E Christofferson
- Veterans Health Administration, Office of Mental Health and Suicide Prevention, 810 Vermont Avenue NW, Washington, DC 20420, United States
| | - Dan V Blalock
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham NC.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2301 Erwin Road, Durham, NC 27705, United States
| | - Jennifer Knoeppel
- Veterans Health Administration, Office of Mental Health and Suicide Prevention, 810 Vermont Avenue NW, Washington, DC 20420, United States
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2301 Erwin Road, Durham, NC 27705, United States.,Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC 27705, United States.,VA Mid-Atlantic Mental Illness Research Education and Clinical Center, 508 Fulton Street, Durham, NC 27705, United States
| | - Kim Hamlett-Berry
- Veterans Health Administration, Office of Mental Health and Suicide Prevention, 810 Vermont Avenue NW, Washington, DC 20420, United States
| | - Jeffrey S Hertzberg
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2301 Erwin Road, Durham, NC 27705, United States.,Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC 27705, United States
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