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Vinci C, Lam CY, Etcheverry PE, Correa-Fernandez V, Cano MÁ, Cinciripini PM, Wetter DW. Co-action and changes in alcohol use during a smoking cessation attempt. Addiction 2024; 119:1059-1070. [PMID: 38482972 DOI: 10.1111/add.16472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 02/08/2024] [Indexed: 05/08/2024]
Abstract
AIMS Three smoking cessation studies (CARE, Break Free, Por Nuestra Salud [PNS]) were used to measure changes in average alcohol consumption, binge drinking and alcohol-related problems during a smoking cessation attempt and to explore co-action with smoking abstinence. DESIGN CARE and PNS were longitudinal cohort cessation studies; Break Free was a two-arm randomized clinical trial. SETTING Texas, USA. PARTICIPANTS Participants were current smokers who were recruited from the community and received smoking cessation interventions. All participants received nicotine replacement therapy and smoking cessation counseling. CARE included 424 smokers (1/3 White, 1/3 African American and 1/3 Latino); Break Free included 399 African American smokers; PNS included 199 Spanish-speaking Mexican-American smokers. MEASUREMENTS Weekly alcohol consumption was collected multiple times pre and post-quit, and binge drinking and alcohol-related problems were collected at baseline and 26 weeks post-quit. Analyses included only those who indicated current alcohol use. FINDINGS Average alcohol consumption decreased from baseline to 26 weeks post-quit in CARE (F = 17.09, P < 0.001), Break Free (F = 12.08, P < 0.001) and PNS (F = 10.21, P < 0.001). Binge drinking decreased from baseline to 26 weeks post-quit in CARE (F = 3.94, P = 0.04) and Break Free (F = 10.41, P < 0.001) but not PNS. Alcohol-related problems decreased from baseline to 26 weeks post-quit in CARE (Chi-sq = 6.41, P = 0.010) and Break Free (Chi sq = 14.44, P = 0.001), but not PNS. CONCLUSIONS Among current drinkers, alcohol use/problems appear to decrease during a smoking cessation attempt and remain low through 26 weeks after the quit attempt. Little evidence was found for co-action, with smoking abstainers and relapsers showing similar change in alcohol use/problems.
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Affiliation(s)
- Christine Vinci
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Cho Y Lam
- School of Medicine, Huntsman Cancer Institute and the Spence Fox Eccles School of Medicine, at the University of Utah, Salt Lake City, UT, USA
| | - Paul E Etcheverry
- Department of Psychology, Southern Illinois University, Carbondale, IL, USA
| | | | - Miguel Ángel Cano
- School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David W Wetter
- School of Medicine, Huntsman Cancer Institute and the Spence Fox Eccles School of Medicine, at the University of Utah, Salt Lake City, UT, USA
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Del Fiol G, Orleans B, Kuzmenko TV, Chipman J, Greene T, Martinez A, Wirth J, Meads R, Kaphingst KK, Gibson B, Kawamoto K, King AJ, Siaperas T, Hughes S, Pruhs A, Pariera Dinkins C, Lam CY, Pierce JH, Benson R, Borsato EP, Cornia R, Stevens L, Bradshaw RL, Schlechter CR, Wetter DW. SCALE-UP II: protocol for a pragmatic randomised trial examining population health management interventions to increase the uptake of at-home COVID-19 testing in community health centres. BMJ Open 2024; 14:e081455. [PMID: 38508633 PMCID: PMC10961568 DOI: 10.1136/bmjopen-2023-081455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION SCALE-UP II aims to investigate the effectiveness of population health management interventions using text messaging (TM), chatbots and patient navigation (PN) in increasing the uptake of at-home COVID-19 testing among patients in historically marginalised communities, specifically, those receiving care at community health centres (CHCs). METHODS AND ANALYSIS The trial is a multisite, randomised pragmatic clinical trial. Eligible patients are >18 years old with a primary care visit in the last 3 years at one of the participating CHCs. Demographic data will be obtained from CHC electronic health records. Patients will be randomised to one of two factorial designs based on smartphone ownership. Patients who self-report replying to a text message that they have a smartphone will be randomised in a 2×2×2 factorial fashion to receive (1) chatbot or TM; (2) PN (yes or no); and (3) repeated offers to interact with the interventions every 10 or 30 days. Participants who do not self-report as having a smartphone will be randomised in a 2×2 factorial fashion to receive (1) TM with or without PN; and (2) repeated offers every 10 or 30 days. The interventions will be sent in English or Spanish, with an option to request at-home COVID-19 test kits. The primary outcome is the proportion of participants using at-home COVID-19 tests during a 90-day follow-up. The study will evaluate the main effects and interactions among interventions, implementation outcomes and predictors and moderators of study outcomes. Statistical analyses will include logistic regression, stratified subgroup analyses and adjustment for stratification factors. ETHICS AND DISSEMINATION The protocol was approved by the University of Utah Institutional Review Board. On completion, study data will be made available in compliance with National Institutes of Health data sharing policies. Results will be disseminated through study partners and peer-reviewed publications. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT05533918 and NCT05533359.
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Affiliation(s)
- Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Brian Orleans
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Tatyana V Kuzmenko
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Jonathan Chipman
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Tom Greene
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Anna Martinez
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Jennifer Wirth
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Ray Meads
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | | | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Andy J King
- Department of Communication, University of Utah, Salt Lake City, Utah, USA
| | - Tracey Siaperas
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | - Shlisa Hughes
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | - Alan Pruhs
- Association for Utah Community Health, Salt Lake City, Utah, USA
| | | | - Cho Y Lam
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Joni H Pierce
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ryzen Benson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Emerson P Borsato
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ryan Cornia
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Leticia Stevens
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Richard L Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - David W Wetter
- Center for Health Outcomes and Population Equity, University of Utah Health Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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3
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Schlechter CR, Del Fiol G, Jones DR, Orleans B, Gibson B, Nahum-Shani I, Maxfield E, Locke A, Cornia R, Bradshaw R, Wirth J, Jaggers SJ, Lam CY, Wetter DW. Increasing the reach of evidence-based interventions for weight management and diabetes prevention among Medicaid patients: study protocol for a pilot Sequential Multiple Assignment Randomised Trial. BMJ Open 2023; 13:e075157. [PMID: 38011967 PMCID: PMC10685946 DOI: 10.1136/bmjopen-2023-075157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/16/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Over 40% of US adults meet criteria for obesity, a major risk factor for chronic disease. Obesity disproportionately impacts populations that have been historically marginalised (eg, low socioeconomic status, rural, some racial/ethnic minority groups). Evidence-based interventions (EBIs) for weight management exist but reach less than 3% of eligible individuals. The aims of this pilot randomised controlled trial are to evaluate feasibility and acceptability of dissemination strategies designed to increase reach of EBIs for weight management. METHODS AND ANALYSIS This study is a two-phase, Sequential Multiple Assignment Randomized Trial, conducted with 200 Medicaid patients. In phase 1, patients will be individually randomised to single text message (TM1) or multiple text messages (TM+). Phase 2 is based on treatment response. Patients who enrol in the EBI within 12 weeks of exposure to phase 1 (ie, responders) receive no further interventions. Patients in TM1 who do not enrol in the EBI within 12 weeks of exposure (ie, TM1 non-responders) will be randomised to either TM1-Continued (ie, no further TM) or TM1 & MAPS (ie, no further TM, up to 2 Motivation And Problem Solving (MAPS) navigation calls) over the next 12 weeks. Patients in TM+ who do not enrol in the EBI (ie, TM+ non-responders) will be randomised to either TM+Continued (ie, monthly text messages) or TM+ & MAPS (ie, monthly text messages, plus up to 2 MAPS calls) over the next 12 weeks. Descriptive statistics will be used to characterise feasibility (eg, proportion of patients eligible, contacted and enrolled in the trial) and acceptability (eg, participant opt-out, participant engagement with dissemination strategies, EBI reach (ie, the proportion of participants who enrol in EBI), adherence, effectiveness). ETHICS AND DISSEMINATION Study protocol was approved by the University of Utah Institutional Review Board (#00139694). Results will be disseminated through study partners and peer-reviewed publications. TRIAL REGISTRATION NUMBER clinicaltrials.gov; NCT05666323.
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Affiliation(s)
- Chelsey R Schlechter
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Dusti R Jones
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Brian Orleans
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Ellen Maxfield
- Osher Center for Integrative Health, University of Utah, Salt Lake City, Utah, USA
- Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Amy Locke
- Osher Center for Integrative Health, University of Utah, Salt Lake City, Utah, USA
- Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ryan Cornia
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Richard Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer Wirth
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Shanna J Jaggers
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Cho Y Lam
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
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Forray A, Gunter-Riley RG, Maltz C, Waters AJ. Pilot study of attentional retraining for postpartum smoking relapse. Front Psychiatry 2023; 14:1231702. [PMID: 37900298 PMCID: PMC10603252 DOI: 10.3389/fpsyt.2023.1231702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/07/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Tobacco smoking is a leading cause of preventable death worldwide. The perinatal period provides a unique opportunity for intervention, as many smokers quit smoking during pregnancy but relapse postpartum. Novel relapse prevention interventions that reduce the burden of treatment attendance in this population are needed. Attentional retraining (AR) has been shown to reduce attentional biases toward smoking-related stimuli, a cognitive process implicated in smoking, AR has not been applied to perinatal smokers, and the effect of AR on craving and smoking is not clear. The goal of this study was to evaluate the delivery of AR for smoking cues in perinatal smokers utilizing a mobile intervention. Methods This pilot study utilized Ecological Momentary Assessment (EMA) methodology delivered on a mobile device to examine the relapse process and evaluate the utility of AR in former smokers attempting to remain abstinent postpartum. AR (or Control Training) was administered to abstinent smokers (N = 17) for up to 2 weeks both before and after delivery. Results All 17 participants completed the study. There was evidence that AR reduced attentional bias in the AR group (vs. Controls). There was no evidence that AR reduced craving. An exploratory analysis revealed that there was no evidence that AR reduced smoking during the study period. Discussion AR using EMA methodology via a mobile device is feasible in perinatal smokers. Further research using larger samples is required to evaluate the utility of mobile AR in reducing craving and smoking.
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Affiliation(s)
- Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - R. Gwen Gunter-Riley
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Caro Maltz
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Andrew J. Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Stump TK, Wetter DW, Kuzmenko T, Orleans B, Kolp L, Wirth J, Del Fiol G, Chipman J, Haaland B, Kaphingst KA, Hersh AL, Wu YP. Preliminary Reach of an Information Technology Approach to Support COVID-19 Testing in Schools. Pediatrics 2023; 152:e2022060352E. [PMID: 37394508 PMCID: PMC10312282 DOI: 10.1542/peds.2022-060352e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES SCALE-UP Counts tests population health management interventions to promote coronavirus disease 2019 (COVID-19) testing in kindergarten through 12th-grade schools that serve populations that have been historically marginalized. METHODS Within 6 participating schools, we identified 3506 unique parents/guardians who served as the primary contact for at least 1 student. Participants were randomized to text messaging (TM), text messaging + health navigation (HN) (TM + HN), or usual care. Bidirectional texts provided COVID-19 symptom screening, along with guidance on obtaining and using tests as appropriate. If parents/guardians in the TM + HN group were advised to test their child but either did not test or did not respond to texts, they were called by a trained health navigator to address barriers. RESULTS Participating schools served a student population that was 32.9% non-white and 15.4% Hispanic, with 49.6% of students eligible to receive free lunches. Overall, 98.8% of parents/guardians had a valid cell phone, of which 3.8% opted out. Among the 2323 parents/guardians included in the intervention, 79.6% (n = 1849) were randomized to receive TM, and 19.1% (n = 354) engaged with TM (ie, responded to at least 1 message). Within the TM + HN group (40.1%, n = 932), 1.3% (n = 12) qualified for HN at least once, of which 41.7% (n = 5) talked to a health navigator. CONCLUSIONS TM and HN are feasible ways to reach parents/guardians of kindergarten through 12th-grade students to provide COVID-19 screening messages. Strategies to improve engagement may strengthen the impact of the intervention.
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Affiliation(s)
- Tammy K. Stump
- Departments of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - David W. Wetter
- Population Health Sciences
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Brian Orleans
- Population Health Sciences
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Leighann Kolp
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jennifer Wirth
- Population Health Sciences
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Jonathan Chipman
- Population Health Sciences
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Benjamin Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | | | - Yelena P. Wu
- Departments of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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Jones SR, Vidrine DJ, Wetter DW, Shih YCT, Sutton SK, Ramondetta LM, Elting LS, Walker JL, Smith KM, Frank-Pearce SG, Li Y, Simmons VN, Vidrine JI. Evaluation of the Efficacy of a Smoking Cessation Intervention for Cervical Cancer Survivors and Women With High-Grade Cervical Dysplasia: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e34502. [PMID: 34967755 PMCID: PMC8765796 DOI: 10.2196/34502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of smoking among cervical cancer survivors is strikingly high, yet no smoking cessation interventions to date have specifically targeted this population. This paper describes the study design, methods, and data analysis plans for a randomized clinical trial designed to evaluate the efficacy of a theoretically and empirically based Motivation And Problem Solving (MAPS) approach for promoting and facilitating smoking cessation among cervical cancer survivors. MAPS is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory-based treatment strategies within an overarching motivational framework. MAPS is designed to be appropriate for all smokers regardless of their motivation to change and views motivation as dynamically fluctuating from moment to moment throughout the behavior change process. OBJECTIVE This 2-group randomized controlled trial compares the efficacy of standard treatment to MAPS in facilitating smoking cessation among women with a history of high-grade cervical dysplasia or cervical cancer. METHODS Participants (N=202) are current smokers with a history of high-grade cervical dysplasia or cervical cancer recruited nationally and randomly assigned to one of two treatment conditions: (1) standard treatment (ST) or (2) MAPS. ST consists of repeated letters referring participants to their state's tobacco cessation quitline, standard self-help materials, and free nicotine replacement therapy when ready to quit. MAPS has all ST components along with 6 proactive telephone counseling sessions delivered over 12 months. The primary outcome is abstinence from tobacco at 18 months. Secondary outcomes include abstinence over time across all assessment points, abstinence at other individual assessment time points, quit attempts, cigarettes per day, and use of state quitlines. Hypothesized treatment mechanisms and cost-effectiveness will also be evaluated. RESULTS This study was approved by the institutional review boards at the University of Texas MD Anderson Cancer Center, the University of Oklahoma Health Sciences Center, and Moffitt Cancer Center. Participant enrollment concluded at Moffitt Cancer Center in January 2020, and follow-up data collection was completed in July 2021. Data analysis is ongoing. CONCLUSIONS This study will yield crucial information regarding the efficacy and cost-effectiveness of a MAPS approach for smoking cessation tailored to the specific needs of women with a history of high-grade cervical dysplasia or cervical cancer. Findings indicating that MAPS has substantially greater efficacy than existing evidence-based tobacco cessation treatments would have tremendous public health significance. TRIAL REGISTRATION ClinicalTrials.gov NCT02157610; https://clinicaltrials.gov/ct2/show/NCT02157610. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34502.
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Affiliation(s)
- Sarah R Jones
- Tobacco Research & Intervention Program, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Damon J Vidrine
- Tobacco Research & Intervention Program, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - David W Wetter
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States
| | - Lois M Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Linda S Elting
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Joan L Walker
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.,Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Katie M Smith
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Summer G Frank-Pearce
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.,TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vani N Simmons
- Tobacco Research & Intervention Program, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Jennifer I Vidrine
- Tobacco Research & Intervention Program, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
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Vinci C, Lam C, Schlechter CR, Shono Y, Vidrine JI, Wetter DW. Increasing treatment enrollment among smokers who are not motivated to quit: a randomized clinical trial. Transl Behav Med 2021; 12:6356542. [PMID: 34424337 DOI: 10.1093/tbm/ibab114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is a significant research-to-practice gap with respect to reaching underserved populations with evidence-based tobacco cessation treatments. Increasing enrollment in evidence-based treatments is necessary to reduce tobacco use and tobacco-related health inequities. The purpose of the current study was to evaluate whether Motivation And Problem Solving (MAPS), a flexible, holistic counseling/navigation approach delivered via phone, and proactive provision of Nicotine Replacement Therapy (NRT) would improve Quitline enrollment among a sample of low SES smokers who were not motivated to quit. In a 3×2 factorial design, cigarette smokers (N = 603) were randomized to one of six treatment conditions (Standard Treatment, MAPS-6, or MAPS-12 by NRT or no NRT). Results indicated that both MAPS-6 and MAPS-12 increased Quitline enrollment compared to Standard Treatment (ps < .03). There were no differences between MAPS conditions. NRT did not increase Quitline enrollment. MAPS is an effective intervention with the potential to be disseminated and implemented in healthcare and community settings to increase the reach of evidence-based interventions for tobacco cessation.
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Affiliation(s)
- Christine Vinci
- Moffitt Cancer Center, Tampa, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Cho Lam
- University of Utah and the Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | - Yusuke Shono
- University of Utah and the Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Jennifer I Vidrine
- Moffitt Cancer Center, Tampa, FL, USA.,University of South Florida, Tampa, FL, USA
| | - David W Wetter
- University of Utah and the Huntsman Cancer Institute, Salt Lake City, UT, USA
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Addressing Smoking Cessation among Women in Substance Use Treatment: A Qualitative Approach to Guiding Tailored Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115764. [PMID: 34072064 PMCID: PMC8198796 DOI: 10.3390/ijerph18115764] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 12/27/2022]
Abstract
Intersecting socially marginalized identities and unique biopsychosocial factors place women with substance use disorders (SUDs) experiencing myriad disadvantages at higher risk for smoking and stigmatization. Here, based on our work with women receiving care for SUDs in four participating treatment/women-serving centers (N = 6 individual clinics), we: (1) describe the functions of smoking for women with SUDs; and (2) explore participants’ experiences of a comprehensive tobacco-free workplace (TFW) program, Taking Texas Tobacco-Free (TTTF), that was implemented during their SUD treatment. Ultimately, information gleaned was intended to inform the development of women-tailored tobacco interventions. Data collection occurred pre- and post-TTTF implementation and entailed conducting client (7) and clinician (5) focus groups. Using thematic analysis, we identified four main themes: “the social context of smoking,” “challenges to finding support and better coping methods,” “addressing underlying conditions: building inner and outer supportive environments,” and “sustaining support: TFW program experiences.” Women reported that: smoking served as a “coping mechanism” for stress and facilitated socialization; stigmatization hindered quitting; non-stigmatizing counseling cessation support provided alternative coping strategies; and, with clinicians, the cessation opportunities TTTF presented are valuable. Clinicians reported organizational support, or lack thereof, and tobacco-related misconceptions as the main facilitator/barriers to treating tobacco addiction. Effective tobacco cessation interventions for women with SUDs should be informed by, and tailored to, their gendered experiences, needs, and recommendations. Participants recommended replacing smoking with healthy stress alleviating strategies; the importance of adopting non-judgmental, supportive, cessation interventions; and the support of TFW programs and nicotine replacement therapy to aid in quitting.
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Tagai EK, Miller SM, Belfiglio A, Xu J, Wen KY, Hernandez E. Persistent Barriers to Smoking Cessation Among Urban, Underserved Women: A Feasibility Study of Tailored Barriers Text Messages. Matern Child Health J 2020; 24:1308-1317. [PMID: 32557133 DOI: 10.1007/s10995-020-02963-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Despite health risks for themselves and their children, urban underserved women smoke at high rates postpartum. The postpartum period is a stressful transition time that presents unique barriers to sustained cessation. There is limited extant evidence of efficacious psychosocial programs to maintain postpartum smoking cessation. METHODS Guided by the Cognitive-Social Health Information Processing model, we explored the feasibility of TxT2Commit, a text-messaging intervention designed to prevent postpartum smoking relapse. Participants (n = 43) received supportive cessation-focused text messages for one month postpartum. Using a convergent mixed method design, surveys and interviews assessed changes in psychosocial factors and smoking status through a three month follow-up. RESULTS Participants reported satisfaction with TxT2Commit, rating text messages as helpful, understandable, supportive, and not bothersome. However, a majority of women (n = 28, 65.1%) relapsed by three months. Participants who stayed smoke free (i.e., non-relapsers) reported significantly less temptation to smoke at one and three months postpartum compared to relapsers (ps < .01). While relapsers had significantly less temptation at one month compared to baseline, temptation increased by three months (p < .01). Consistent with the quantitative results, qualitative interviews identified informational and coping needs, with continued temptation throughout the three months. Non-relapsers were able to manage temptation and reported greater support. CONCLUSIONS FOR PRACTICE TxT2Commit demonstrates preliminary feasibility and acceptability among urban, underserved postpartum women. However, most participants relapsed by three months postpartum. Additional research is needed to identify targeted messaging to best help women avoid temptation and bolster support to stay smoke free in this uniquely stressful period.
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Affiliation(s)
- E K Tagai
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - S M Miller
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
| | - A Belfiglio
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - J Xu
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - K Y Wen
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
- Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut Street, Suite 314, Philadelphia, PA, 19107, USA
| | - E Hernandez
- Obstetrics, Gynecology, and Reproductive Sciences, Lewis Katz School of Medicine, Temple University, 3500 N. Broad Street, Philadelphia, PA, 19410, USA
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10
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Kocataş S, Güler N, Sezer RE. Factors Affecting Smoking Behaviors and Smoking Prevalence in Pregnancy and Postpartum Period of Women. Florence Nightingale Hemsire Derg 2020; 28:230-242. [PMID: 34263202 PMCID: PMC8152163 DOI: 10.5152/fnjn.2020.18031] [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: 08/28/2018] [Accepted: 09/12/2019] [Indexed: 11/22/2022] Open
Abstract
Aim This study aimed to determine the factors affecting smoking behaviors and smoking prevalence among women during pregnancy and postpartum period. Method This cross-sectional study was conducted between May 2012 and October 2012 on a sample of 640 women who had children aged between one and three years and who enrolled in any one of the 23 family health centers located in the province of Sivas in Turkey. The data were collected through the questionnaires created by the researchers by interviewing the participants face to face in own homes. The data obtained were analyzed using the Statistical Package for the Social Sciences Statistics 15.0 (SPSS Inc.; Chicago, IL, USA) package program and evaluated using number, percentage distribution, chi square test, logistic regression analysis and Kaplan-Meier survival analysis. Results Smoking prevalence was found to be 8% during pregnancy and 15.6% in the postpartum period. It was determined that 17.2% of the women smoked before their last pregnancy (n=110), more than half of the smokers quit smoking during pregnancy (n=59), and 46.4% of them continued to smoke during pregnancy. It was determined that 79.7% of the participants who quit smoking during pregnancy relapsed within the first one to three years of the postpartum period, and only 20.3% continued not to smoke. The Kaplan-Meier survival analysis showed that women who breastfed quit smoking for a significantly longer time (27.6 months) compared with those who did not breastfeed (12 months). According to the logistic regression analysis, the risk of postpartum relapse among women aged 30 years or more was 10.99-fold higher than women between the ages of 19 and 29. Conclusion The rate of pre-pregnancy smokers decreased in the pregnancy and increased in the postpartum period.
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Affiliation(s)
- Semra Kocataş
- Department of Public Health Nursing, Sivas Cumhuriyet University Faculty of Health Science, Sivas, Turkey
| | - Nuran Güler
- Department of Public Health Nursing, Sivas Cumhuriyet University Faculty of Health Science, Sivas, Turkey
| | - Recep Erol Sezer
- Department of Public Health and Familiy Medicine, Yeditepe University, Faculty of Medicine, İstanbul, Turkey
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11
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Dascal M, Rusu A, Onisor A, Blaga O, Miller M, Meghea C. An mHealth intervention to prevent postnatal smoking relapse: The RESPREMO study protocol. Tob Prev Cessat 2020; 6:24. [PMID: 32548361 PMCID: PMC7291910 DOI: 10.18332/tpc/118724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 12/21/2022]
Abstract
Up to 70% of women who quit smoking relapse after birth, usually within 3 months postpartum. The wide adoption of mobile technologies, especially smartphones, in recent years in low- and middle-income countries (LMICs) offers the possibility of low-cost, novel, and innovative mobile phone-based interventions for smoking relapse prevention. This study presents the protocol of the RESPREMO clinical trial for postnatal smoking relapse prevention for enrolled women, who recently gave birth and quit tobacco smoking before or during pregnancy, and their life partners. This work relies on data collected in two of the largest government-owned obstetrics and gynecology clinics in Cluj-Napoca, Romania. Seventy-five couples were randomized into one of three groups: a) 24 couples were allocated to the first intervention group and asked to install and use the xSmoker app; b) 26 couples were randomized to the second intervention group, who, in addition to the use of the xSmoker app, received text messages with content focused on motivation, problem solving, and dyadic efficacy; and c) 25 couples were randomized into a control group. Several measures of engagement with the xSmoker app were assessed, including duration of app use, the frequency of utilizing the tool to calculate savings from quitting, number of app-delivered challenges accepted by users, and number of app-delivered cessation and abstinence tips. If effective, RESPREMO is expected to have a sustainable impact on the prevention of postnatal relapse tobacco smoking with positive effects for both the mother and the newborn. The implications are beyond tobacco control, and relevant to the design and implementation of other mHealth behavioral interventions focused on the pregnancy and reproductive years in general.
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Affiliation(s)
- Marina Dascal
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Andreea Rusu
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Alexandra Onisor
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Oana Blaga
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Mckenzie Miller
- College of Human Medicine, Michigan State University, East Lansing, United States
| | - Cristian Meghea
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.,Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.,Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, United States
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12
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Fernandez ME, Schlechter CR, Del Fiol G, Gibson B, Kawamoto K, Siaperas T, Pruhs A, Greene T, Nahum-Shani I, Schulthies S, Nelson M, Bohner C, Kramer H, Borbolla D, Austin S, Weir C, Walker TW, Lam CY, Wetter DW. QuitSMART Utah: an implementation study protocol for a cluster-randomized, multi-level Sequential Multiple Assignment Randomized Trial to increase Reach and Impact of tobacco cessation treatment in Community Health Centers. Implement Sci 2020; 15:9. [PMID: 32000812 PMCID: PMC6993416 DOI: 10.1186/s13012-020-0967-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/13/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Tobacco use remains the leading cause of death and disability in the USA and is disproportionately concentrated among low socioeconomic status (SES) populations. Community Health Centers (CHCs) are a key venue for reaching low SES populations with evidence-based tobacco cessation treatment such as Quitlines. Electronic health record (EHR)-based interventions at the point-of-care, text messaging (TM), and phone counseling have the potential to increase Quitline reach and are feasible to implement within CHCs. However, there is a lack of data to inform how, when, and in what combination these strategies should be implemented. The aims of this cluster-randomized trial are to evaluate multi-level implementation strategies to increase the Reach (i.e., proportion of tobacco-using patients who enroll in the Quitline) and Impact (i.e., Reach × Efficacy [efficacy is defined as the proportion of tobacco-using patients who enroll in Quitline treatment that successfully quit]) and to evaluate characteristics of healthcare system, providers, and patients that may influence tobacco-use outcomes. METHODS This study is a multilevel, three-phase, Sequential Multiple Assignment Randomized Trial (SMART), conducted in CHCs (N = 33 clinics; N = 6000 patients). In the first phase, clinics will be randomized to two different EHR conditions. The second and third phases are patient-level randomizations based on prior treatment response. Patients who enroll in the Quitline receive no further interventions. In phase two, patients who are non-responders (i.e., patients who do not enroll in Quitline) will be randomized to receive either TM or continued-EHR. In phase three, patients in the TM condition who are non-responders will be randomized to receive either continued-TM or TM + phone coaching. DISCUSSION This project will evaluate scalable, multi-level interventions to directly address strategic national priorities for reducing tobacco use and related disparities by increasing the Reach and Impact of evidence-based tobacco cessation interventions in low SES populations. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov (NCT03900767) on April 4th, 2019.
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Affiliation(s)
- Maria E Fernandez
- Center for Health Promotion and Prevention Research, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St, Houston, TX, 77030, USA
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA.
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Tracey Siaperas
- Association for Utah Community Health, 860 E 4500 S, Murray, UT, 84107, USA
| | - Alan Pruhs
- Association for Utah Community Health, 860 E 4500 S, Murray, UT, 84107, USA
| | - Tom Greene
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI, 48104, USA
| | - Sandra Schulthies
- Utah Department of Health, 288 N 1460 W, Salt Lake City, UT, 84116, USA
| | - Marci Nelson
- Utah Department of Health, 288 N 1460 W, Salt Lake City, UT, 84116, USA
| | - Claudia Bohner
- Utah Department of Health, 288 N 1460 W, Salt Lake City, UT, 84116, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Sharon Austin
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA
| | - Timothy W Walker
- Center for Health Promotion and Prevention Research, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St, Houston, TX, 77030, USA
| | - Cho Y Lam
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - David W Wetter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
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13
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Levine MD, Emery RL, Kolko Conlon RP, Marcus MD, Germeroth LJ, Salk RH, Cheng Y. Depressive Symptoms Assessed Near the End of Pregnancy Predict Differential Response to Postpartum Smoking Relapse Prevention Intervention. Ann Behav Med 2020; 54:119-124. [PMID: 31219152 PMCID: PMC7170725 DOI: 10.1093/abm/kaz026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depressive symptoms are prevalent during pregnancy and the postpartum period and affect risk for smoking relapse. Whether and how depression affects response to postpartum interventions designed to sustain smoking abstinence is unknown. PURPOSE We examined end-of-pregnancy depressive symptoms as a moderator of response to two postpartum-adapted smoking relapse prevention interventions. METHODS Women (N = 300) who quit smoking during pregnancy were randomized to receive either a postpartum intervention focused on psychosocial factors linked to postpartum smoking (Strategies to Avoid Returning to Smoking [STARTS]) or an attention-controlled comparison intervention (SUPPORT). Women completed the Edinburgh Postnatal Depression Scale at the end of pregnancy. Smoking status was biochemically assessed at the end of pregnancy and at 12, 24, and 52 weeks postpartum. RESULTS End-of-pregnancy depressive symptoms moderated response to postpartum smoking relapse prevention interventions (χ2 = 10.18, p = .001). After controlling for variables previously linked to postpartum smoking relapse, women with clinically significant end-of-pregnancy depressive symptoms (20%) were more likely to sustain abstinence through 52 weeks postpartum if they received STARTS. In contrast, women with few end-of-pregnancy depressive symptoms were more likely to sustain abstinence through 52 weeks postpartum if they received SUPPORT. Changes in the psychosocial factors addressed in the STARTS intervention did not mediate this moderation effect. CONCLUSION Assessment of end-of-pregnancy depressive symptoms may help determine success following postpartum smoking relapse prevention interventions. Women with elevated end-of-pregnancy depressive symptoms benefited from postpartum relapse prevention intervention tailored to their psychosocial needs, while those with few symptoms were more successful in postpartum intervention that used standard behavioral components. CLINICAL TRIAL REGISTRATION NCT00757068.
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Affiliation(s)
- Michele D Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rebecca L Emery
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Marsha D Marcus
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lisa J Germeroth
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rachel H Salk
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yu Cheng
- Department of Statistics and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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14
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Livingstone‐Banks J, Norris E, Hartmann‐Boyce J, West R, Jarvis M, Chubb E, Hajek P. Relapse prevention interventions for smoking cessation. Cochrane Database Syst Rev 2019; 2019:CD003999. [PMID: 31684681 PMCID: PMC6816175 DOI: 10.1002/14651858.cd003999.pub6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND A number of treatments can help smokers make a successful quit attempt, but many initially successful quitters relapse over time. Several interventions have been proposed to help prevent relapse. OBJECTIVES To assess whether specific interventions for relapse prevention reduce the proportion of recent quitters who return to smoking. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group trials register, clinicaltrials.gov, and the ICTRP in May 2019 for studies mentioning relapse prevention or maintenance in their title, abstracts, or keywords. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of relapse prevention interventions with a minimum follow-up of six months. We included smokers who quit on their own, were undergoing enforced abstinence, or were participating in treatment programmes. We included studies that compared relapse prevention interventions with a no intervention control, or that compared a cessation programme with additional relapse prevention components with a cessation programme alone. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 81 studies (69,094 participants), five of which are new to this update. We judged 22 studies to be at high risk of bias, 53 to be at unclear risk of bias, and six studies to be at low risk of bias. Fifty studies included abstainers, and 30 studies helped people to quit and then tested treatments to prevent relapse. Twenty-eight studies focused on special populations who were abstinent because of pregnancy (19 studies), hospital admission (six studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy. We focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses we conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, risk ratio (RR) 1.23, 95% confidence interval (CI) 1.08 to 1.41, I2 = 82%; moderate-certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and nicotine replacement therapy (NRT) in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I2 = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide confidence intervals consistent with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I2 = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40, I2 = 0%; low-certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I2 = 0%; moderate-certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I2 = 66%; low-certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at the end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I2 = 0%) and at postpartum follow-up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I2 = 3%), studies in hospital inpatients (5 studies, n = 1385, RR 1.10, 95% CI 0.82 to 1.47, I2 = 58%), and studies in assisted abstainers (11 studies, n = 5523, RR 0.98, 95% CI 0.87 to 1.11, I2 = 52%; moderate-certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I2 = 1%) from the general population. AUTHORS' CONCLUSIONS Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means we are only moderately certain of this. In people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard. Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity. Moderate-certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though confidence intervals mean we could not rule out a clinically important benefit at this stage. Low-certainty evidence, limited by imprecision, did not show a benefit of extended treatment with nicotine replacement therapy in preventing relapse in assisted abstainers. More research is needed in this area, especially as the evidence for extended nicotine replacement therapy in unassisted abstainers did suggest a benefit.
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Affiliation(s)
| | - Emma Norris
- University College LondonCentre for Behaviour ChangeLondonUK
| | | | - Robert West
- University College LondonDepartment of Behavioural Science and Health1‐19 Torrington PlaceLondonUKWC1E 6BT
| | - Martin Jarvis
- University College LondonHealth Behavior Research Centre of Cancer Research UK, Department of Epidemiology and Public Health2‐16 Torrington PlaceLondonUKWC1E 6BT
| | - Emma Chubb
- Cardiff UniversitySchool of PsychologyCardiffUK
| | - Peter Hajek
- Barts & The London School of Medicine and Dentistry, Queen Mary University of LondonWolfson Institute of Preventive Medicine55 Philpot StreetLondonUKE1 2HJ
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15
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Coleman-Cowger VH, Mark KS, Rosenberry ZR, Koszowski B, Terplan M. A Pilot Randomized Controlled Trial of a Phone-based Intervention for Smoking Cessation and Relapse Prevention in the Postpartum Period. J Addict Med 2019; 12:193-200. [PMID: 29351139 PMCID: PMC5970014 DOI: 10.1097/adm.0000000000000385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To pilot-test a Phone-based Postpartum Continuing Care (PPCC) protocol developed from existing evidence-based approaches to address both postpartum smoking relapse among low-income women who quit smoking during pregnancy and postpartum smoking increase among those who had cut down. METHODS One hundred thirty low-income pregnant women who were current or recently quit tobacco smokers were recruited at their first prenatal appointment and randomized to either a Control (standard care) or Experimental (standard care + PPCC) group. An intent-to-treat analysis was conducted on biochemically verified data from 6 in-person interviews during pregnancy and postpartum. Feasibility with regard to recruitment, randomization, assessment, and implementation of PPCC were assessed, along with acceptability among the target population. RESULTS PPCC was found to be feasible and acceptable to some participants, but not all. There were no significant differences in tobacco products per day at 6 months postpartum between groups; however, effect sizes differed at 6 weeks compared with 6 months postpartum. Similarly, there were no significant differences between groups in cessation rate (24% in each group) and past 90-day tobacco use (59 vs 55 days, for Control and Experimental groups, respectively). CONCLUSIONS The PPCC intervention did not differentially reduce tobacco use postpartum compared with a controlled comparison group, though it was found to be acceptable among a subpopulation of low-income pregnant women and feasible with regard to recruitment, randomization, assessment procedures, and implementation. Further research is needed to identify an intervention that significantly improves smoking relapse rates postpartum.
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Affiliation(s)
| | - Katrina S. Mark
- University of Maryland Baltimore, 11 S Paca Street, Suite 40, Baltimore, MD 21201
| | - Zachary R. Rosenberry
- Battelle Public Health Center for Tobacco Research, 6115 Falls Road, Suite 200, Baltimore, MD 21209
| | - Bartosz Koszowski
- Battelle Public Health Center for Tobacco Research, 6115 Falls Road, Suite 200, Baltimore, MD 21209
| | - Mishka Terplan
- Virginia Commonwealth University, Box 980034 Richmond VA 23298
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16
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Lindson N, Thompson TP, Ferrey A, Lambert JD, Aveyard P. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2019; 7:CD006936. [PMID: 31425622 PMCID: PMC6699669 DOI: 10.1002/14651858.cd006936.pub4] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help people to a make a successful attempt to stop smoking. OBJECTIVES To evaluate the efficacy of MI for smoking cessation compared with no treatment, in addition to another form of smoking cessation treatment, and compared with other types of smoking cessation treatment. We also investigated whether more intensive MI is more effective than less intensive MI for smoking cessation. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register for studies using the term motivat* NEAR2 (interview* OR enhanc* OR session* OR counsel* OR practi* OR behav*) in the title or abstract, or motivation* as a keyword. We also searched trial registries to identify unpublished studies. Date of the most recent search: August 2018. SELECTION CRITERIA Randomised controlled trials in which MI or its variants were offered to smokers to assist smoking cessation. We excluded trials that did not assess cessation as an outcome, with follow-up less than six months, and with additional non-MI intervention components not matched between arms. We excluded trials in pregnant women as these are covered elsewhere. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RR) and 95% confidence intervals (CI) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. We extracted data on mental health outcomes and quality of life and summarised these narratively. MAIN RESULTS We identified 37 eligible studies involving over 15,000 participants who smoked tobacco. The majority of studies recruited participants with particular characteristics, often from groups of people who are less likely to seek support to stop smoking than the general population. Although a few studies recruited participants who intended to stop smoking soon or had no intentions to quit, most recruited a population without regard to their intention to quit. MI was conducted in one to 12 sessions, with the total duration of MI ranging from five to 315 minutes across studies. We judged four of the 37 studies to be at low risk of bias, and 11 to be at high risk, but restricting the analysis only to those studies at low or unclear risk did not significantly alter results, apart from in one case - our analysis comparing higher to lower intensity MI.We found low-certainty evidence, limited by risk of bias and imprecision, comparing the effect of MI to no treatment for smoking cessation (RR = 0.84, 95% CI 0.63 to 1.12; I2 = 0%; adjusted N = 684). One study was excluded from this analysis as the participants recruited (incarcerated men) were not comparable to the other participants included in the analysis, resulting in substantial statistical heterogeneity when all studies were pooled (I2 = 87%). Enhancing existing smoking cessation support with additional MI, compared with existing support alone, gave an RR of 1.07 (95% CI 0.85 to 1.36; adjusted N = 4167; I2 = 47%), and MI compared with other forms of smoking cessation support gave an RR of 1.24 (95% CI 0.91 to 1.69; I2 = 54%; N = 5192). We judged both of these estimates to be of low certainty due to heterogeneity and imprecision. Low-certainty evidence detected a benefit of higher intensity MI when compared with lower intensity MI (RR 1.23, 95% CI 1.11 to 1.37; adjusted N = 5620; I2 = 0%). The evidence was limited because three of the five studies in this comparison were at risk of bias. Excluding them gave an RR of 1.00 (95% CI 0.65 to 1.54; I2 = n/a; N = 482), changing the interpretation of the results.Mental health and quality of life outcomes were reported in only one study, providing little evidence on whether MI improves mental well-being. AUTHORS' CONCLUSIONS There is insufficient evidence to show whether or not MI helps people to stop smoking compared with no intervention, as an addition to other types of behavioural support for smoking cessation, or compared with other types of behavioural support for smoking cessation. It is also unclear whether more intensive MI is more effective than less intensive MI. All estimates of treatment effect were of low certainty because of concerns about bias in the trials, imprecision and inconsistency. Consequently, future trials are likely to change these conclusions. There is almost no evidence on whether MI for smoking cessation improves mental well-being.
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Affiliation(s)
- Nicola Lindson
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Tom P Thompson
- University of PlymouthFaculty of Medicine and DentistryPlymouthDevonUK
| | - Anne Ferrey
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | | | - Paul Aveyard
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
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17
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Hoover DS, Spears CA, Vidrine DJ, Walker JL, Shih YCT, Wetter DW. Smoking Cessation Treatment Needs of Low SES Cervical Cancer Survivors. Am J Health Behav 2019; 43:606-620. [PMID: 31046890 PMCID: PMC6686858 DOI: 10.5993/ajhb.43.3.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: We investigated the treatment needs and preferences of low socioeconomic status cervical cancer survivors to inform the adaptation of a theoretically- and empirically-based Motivation and Problem-Solving approach to facilitate cessation in this at-risk population. Methods: Individual in-depth interviews were conducted with 12 female smokers with cervical cancer. Interviews were audio-recorded, transcribed, and analyzed using NVivo 10. Results: Most participants did not believe that smoking caused cervical cancer and attributed their diagnosis solely to human papillomavirus. They suggested that cessation treatment for cervical cancer survivors include psychoeducation about the impact of smoking on health and cancer and the benefits of quitting, pharmacotherapy, planning for quitting, strategies for coping with cravings/withdrawal, social support, real-time support, a nonjudgmental and understanding counselor, tailoring, and follow-up. They recommended that negativity/judgment and being told that "smoking is bad" not be included in treatment. Participants also suggested that treatment address stress management, issues specific to cervical cancer survivorship, and physical activity and healthy eating. Conclusions: Results highlight the unique treatment needs of low socioeconomic status smokers with cervical cancer and will inform the adaptation of an existing evidence-based inter- vention to encourage smoking cessation in this population.
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Brown TJ, Hardeman W, Bauld L, Holland R, Maskrey V, Naughton F, Orton S, Ussher M, Notley C. A systematic review of behaviour change techniques within interventions to prevent return to smoking postpartum. Addict Behav 2019; 92:236-243. [PMID: 30731328 PMCID: PMC6518963 DOI: 10.1016/j.addbeh.2018.12.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/13/2018] [Accepted: 12/22/2018] [Indexed: 11/04/2022]
Abstract
Introduction There is no routine support to prevent postpartum smoking relapse, due to lack of effective interventions. Previous reviews have identified behaviour change techniques (BCTs) within pregnancy cessation trials to specify which components might be incorporated into more effective interventions, but no reviews have identified BCTs for prevention of smoking relapse postpartum. We reviewed BCTs and potential delivery modes, to inform future interventions. Methods We searched Medline and EMBASE from January 2015–May 2017; and identified trials published before 2015 by handsearching systematic reviews. We included RCTs where: i) ≥1 intervention component aimed to maintain smoking abstinence versus a less intensive intervention; ii) participants included pregnant or postpartum smoking quitters; iii) smoking status was reported in the postpartum period. We extracted trial characteristics and used the Behaviour Change Technique Taxonomy v1 to extract BCTs. We aimed to identify ‘promising’ BCTs i.e. those frequently occurring and present in ≥2 trials that demonstrated long-term effectiveness (≥6 months postpartum). Data synthesis was narrative. Results We included 32 trials, six of which demonstrated long-term effectiveness. These six trials used self-help, mainly in conjunction with counselling, and were largely delivered remotely. We identified six BCTs as promising: ‘problem solving’, ‘information about health consequences’, ‘information about social and environmental consequences’, ‘social support’, ‘reduce negative emotions’ and ‘instruction on how to perform a behaviour’. Conclusions Future interventions to prevent postpartum smoking relapse might include these six BCTs to maximise effectiveness. Tailored self-help approaches, with/without counselling, may be favourable modes of delivery of BCTs. Registration: PROSPERO CRD42018075677. First review of behaviour change techniques to prevent postpartum smoking relapse. Six promising behaviour change techniques (BCTs) were frequently coded. BCTs were problem solving, social support, information about consequences. How to perform a behaviour and reduce negative emotions were also promising BCTs.
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Patten CA, Lando HA, Desnoyers CA, Barrows Y, Klejka J, Decker PA, Hughes CA, Bock MJ, Boyer R, Resnicow K, Burhansstipanov L. The Healthy Pregnancies Project: Study protocol and baseline characteristics for a cluster-randomized controlled trial of a community intervention to reduce tobacco use among Alaska Native pregnant women. Contemp Clin Trials 2019; 78:116-125. [PMID: 30703523 PMCID: PMC6407629 DOI: 10.1016/j.cct.2019.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tobacco use prevalence is high among pregnant Alaska Native (AN) women but few interventions have been evaluated for this group. The Healthy Pregnancies Project aims to evaluate a multicomponent intervention for reducing tobacco use during pregnancy and the postpartum period among AN women. This report describes the study protocol and participant baseline characteristics. DESIGN Cluster-randomized controlled trial with village as the unit of assignment. Sixteen villages in rural southwest Alaska were stratified on village size and randomized to a multicomponent intervention (n = 8 villages) or usual care (n = 8 villages). METHODS Pregnant AN women from the study villages were enrolled. All participants receive the usual care provided to pregnant women in this region. Participants from intervention villages additionally receive individual phone counseling on healthy pregnancies plus a social marketing campaign targeting the entire community delivered by local AN "Native Sisters." Baseline measurements for all enrolled pregnant women have been completed. Follow-up assessments are ongoing at delivery, and at 2 and 6 months postpartum. The primary outcome is biochemically verified tobacco use status at 6 months postpartum. RESULTS Recruitment was feasible with 73% of eligible women screened enrolled. The program reached more than half (56%) of AN pregnant women from the study villages during the recruitment period. Participants are N = 352 pregnant AN women, 188 enrolled from intervention villages and 164 from control villages. At baseline, participants' mean (SD) age was 25.8 (5.0) years, they were at 26.8 (9.8) weeks gestation, and 66.5% were current tobacco users. DISCUSSION Processes and products from this project may have relevance to other Native American populations aiming to focus on healthy pregnancies in their communities.
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Affiliation(s)
- Christi A Patten
- Mayo Clinic, Department of Psychiatry and Psychology, BioBusiness Bldg 5-26, 200 First Street SW, Rochester, MN 55905, USA.
| | - Harry A Lando
- University of Minnesota, 1300 2(nd) St, Ste 200, Minneapolis, MN 55454, USA.
| | - Chris A Desnoyers
- Yukon-Kuskokwim Health Corporation, 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559, USA.
| | - Yvette Barrows
- Yukon-Kuskokwim Health Corporation, 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559, USA.
| | - Joseph Klejka
- Yukon-Kuskokwim Health Corporation, 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559, USA.
| | - Paul A Decker
- Mayo Clinic, Department of Health Sciences Research, Harwick 7, 200 First Street SW, Rochester, MN 55905, USA.
| | - Christine A Hughes
- Mayo Clinic, Department of Psychiatry and Psychology, BioBusiness Bldg 5-26, 200 First Street SW, Rochester, MN 55905, USA.
| | - Martha J Bock
- Mayo Clinic, Department of Psychiatry and Psychology, BioBusiness Bldg 5-26, 200 First Street SW, Rochester, MN 55905, USA.
| | - Rahnia Boyer
- Yukon-Kuskokwim Health Corporation, 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559, USA.
| | - Kenneth Resnicow
- University of Michigan, 109 S. Observatory, 3867 SPH1, Ann Arbor, MI 48109, USA.
| | - Linda Burhansstipanov
- Native American Cancer Initiatives, Inc., 3022 South Nova Road, Pine, CO 80470, USA.
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Livingstone‐Banks J, Norris E, Hartmann‐Boyce J, West R, Jarvis M, Hajek P. Relapse prevention interventions for smoking cessation. Cochrane Database Syst Rev 2019; 2:CD003999. [PMID: 30758045 PMCID: PMC6372978 DOI: 10.1002/14651858.cd003999.pub5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A number of treatments can help smokers make a successful quit attempt, but many initially successful quitters relapse over time. Several interventions have been proposed to help prevent relapse. OBJECTIVES To assess whether specific interventions for relapse prevention reduce the proportion of recent quitters who return to smoking. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group trials register, clinicaltrials.gov, and the ICTRP in February 2018 for studies mentioning relapse prevention or maintenance in their title, abstracts, or keywords. SELECTION CRITERIA Randomised or quasi-randomised controlled trials of relapse prevention interventions with a minimum follow-up of six months. We included smokers who quit on their own, were undergoing enforced abstinence, or were participating in treatment programmes. We included studies that compared relapse prevention interventions with a no intervention control, or that compared a cessation programme with additional relapse prevention components with a cessation programme alone. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 77 studies (67,285 participants), 15 of which are new to this update. We judged 21 studies to be at high risk of bias, 51 to be at unclear risk of bias, and five studies to be at low risk of bias. Forty-eight studies included abstainers, and 29 studies helped people to quit and then tested treatments to prevent relapse. Twenty-six studies focused on special populations who were abstinent because of pregnancy (18 studies), hospital admission (five studies), or military service (three studies). Most studies used behavioural interventions that tried to teach people skills to cope with the urge to smoke, or followed up with additional support. Some studies tested extended pharmacotherapy.We focused on results from those studies that randomised abstainers, as these are the best test of relapse prevention interventions. Of the 12 analyses we conducted in abstainers, three pharmacotherapy analyses showed benefits of the intervention: extended varenicline in assisted abstainers (2 studies, n = 1297, risk ratio (RR) 1.23, 95% confidence interval (CI) 1.08 to 1.41, I² = 82%; moderate certainty evidence), rimonabant in assisted abstainers (1 study, RR 1.29, 95% CI 1.08 to 1.55), and nicotine replacement therapy (NRT) in unaided abstainers (2 studies, n = 2261, RR 1.24, 95% Cl 1.04 to 1.47, I² = 56%). The remainder of analyses of pharmacotherapies in abstainers had wide confidence intervals consistent with both no effect and a statistically significant effect in favour of the intervention. These included NRT in hospital inpatients (2 studies, n = 1078, RR 1.23, 95% CI 0.94 to 1.60, I² = 0%), NRT in assisted abstainers (2 studies, n = 553, RR 1.04, 95% CI 0.77 to 1.40, I² = 0%; low certainty evidence), extended bupropion in assisted abstainers (6 studies, n = 1697, RR 1.15, 95% CI 0.98 to 1.35, I² = 0%; moderate certainty evidence), and bupropion plus NRT (2 studies, n = 243, RR 1.18, 95% CI 0.75 to 1.87, I² = 66%; low certainty evidence). Analyses of behavioural interventions in abstainers did not detect an effect. These included studies in abstinent pregnant and postpartum women at end of pregnancy (8 studies, n = 1523, RR 1.05, 95% CI 0.99 to 1.11, I² = 0%) and at postpartum follow-up (15 studies, n = 4606, RR 1.02, 95% CI 0.94 to 1.09, I² = 3%), studies in hospital inpatients (4 studies, n = 1300, RR 0.95, 95% CI 0.81 to 1.11, I² = 0%), and studies in assisted abstainers (10 studies, n = 5408, RR 0.99, 95% CI 0.87 to 1.13, I² = 56%; moderate certainty evidence) and unaided abstainers (5 studies, n = 3561, RR 1.06, 95% CI 0.96 to 1.16, I² = 1%) from the general population. AUTHORS' CONCLUSIONS Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means we are only moderately certain of this. In people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard. Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained statistical heterogeneity. Moderate-certainty evidence, limited by imprecision, did not detect a benefit from extended treatment with bupropion, though confidence intervals mean we could not rule out a clinically important benefit at this stage. Low-certainty evidence, limited by imprecision, did not show a benefit of extended treatment with nicotine replacement therapy in preventing relapse in assisted abstainers. More research is needed in this area, especially as the evidence for extended nicotine replacement therapy in unassisted abstainers did suggest a benefit.
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Affiliation(s)
| | - Emma Norris
- University College LondonCentre for Behaviour ChangeLondonUK
| | | | - Robert West
- University College LondonDepartment of Behavioural Science and Health1‐19 Torrington PlaceLondonUKWC1E 6BT
| | - Martin Jarvis
- University College LondonHealth Behavior Research Centre of Cancer Research UK, Department of Epidemiology and Public Health2‐16 Torrington PlaceLondonUKWC1E 6BT
| | - Peter Hajek
- Barts & The London School of Medicine and Dentistry, Queen Mary University of LondonWolfson Institute of Preventive Medicine55 Philpot StreetLondonUKE1 2HJ
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Scheffers-van Schayck T, Tuithof M, Otten R, Engels R, Kleinjan M. Smoking Behavior of Women Before, During, and after Pregnancy: Indicators of Smoking, Quitting, and Relapse. Eur Addict Res 2019; 25:132-144. [PMID: 30917383 PMCID: PMC6518863 DOI: 10.1159/000498988] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/15/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Smoking cessation during pregnancy and preventing relapse postpartum is a pivotal public health priority. OBJECTIVES This study examined the risk and protective indicators of women who (a) smoke before pregnancy, (b) smoke during the entire pregnancy, (c) successfully quit smoking during pregnancy, and (d) relapse postpartum. METHOD This paper reports secondary analyses of the Dutch population-based Monitor on Substance Use and Pregnancy (2016). A representative sample of mothers of young children (n = 1,858) completed questionnaires at youth health care centers. Bivariate and multivariate logistic regression analyses were conducted. RESULTS Main results showed that women's smoking around pregnancy was strongly associated with the partner's smoking status before pregnancy, partner's change in smoking during pregnancy, and partner's change in smoking postpartum. Women's educational level and cannabis use before pregnancy were also related with women's smoking before and during pregnancy. Women's intensity of alcohol use before pregnancy was ambiguously related with women's smoking before and during pregnancy. CONCLUSIONS One of the key findings of this study suggests that it is essential that partners quit smoking before pregnancy and do not smoke during pregnancy. If partners continue smoking during pregnancy, they should quit smoking postpartum. Health care professionals can play an important role in addressing partners' smoking and giving them evidence-based cessation support before, during, and after pregnancy.
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Affiliation(s)
- Tessa Scheffers-van Schayck
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Epidemiology and Research Support, Utrecht, The Netherlands,Department of Developmental Psychology, Utrecht University, Utrecht, The Netherlands,*Tessa Scheffers-van Schayck, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Epidemiology and Research Support, Da Costakade 45, Utrecht, 3521 VS (The Netherlands), E-Mail
| | - Marlous Tuithof
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Epidemiology and Research Support, Utrecht, The Netherlands
| | - Roy Otten
- Research and Development, Pluryn, Nijmegen, The Netherlands,ASU REACH Institute, Department of Psychology, Arizona State University, Tempe, Arizona, USA,Developmental Psychopathology, Radboud University, Nijmegen, The Netherlands
| | - Rutger Engels
- Executive Board, Erasmus University, Rotterdam, The Netherlands
| | - Marloes Kleinjan
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Epidemiology and Research Support, Utrecht, The Netherlands,Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands
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Ulrich CM, Himbert C, Boucher K, Wetter DW, Hess R, Kim J, Lundberg K, Ligibel JA, Barnes CA, Rushton B, Marcus R, Finlayson SRG, LaStayo PC, Varghese TK. Precision-Exercise-Prescription in patients with lung cancer undergoing surgery: rationale and design of the PEP study trial. BMJ Open 2018; 8:e024672. [PMID: 30559162 PMCID: PMC6303592 DOI: 10.1136/bmjopen-2018-024672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/05/2018] [Accepted: 09/26/2018] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Lung cancer is a significant burden on societies worldwide, and the most common cause of death in patients with cancer overall. Exercise intervention studies in patients with lung cancer have consistently shown benefits with respect to physical and emotional functioning. However, to date, exercise training has not been consistently implemented into clinical practice given that interventions have been costly and not aligned with clinical care. METHODS/DESIGN The Precision-Exercise-Prescription (PEP) study is a prospective randomised controlled trial comparing the effectiveness and feasibility of a personalised intervention exercise programme among patients with lung cancer undergoing surgery. Two-hundred patients who are diagnosed with stage primary or secondary lung cancer and are eligible to undergo surgical treatment at Huntsman Cancer Institute comprise the target population. Patients are randomised to either the (1) outpatient precision-exercise intervention group or (2) delayed intervention group. The intervention approach uses Motivation and Problem Solving, a hybrid behavioural treatment based on motivational interviewing and practical problem solving. The dosage of the exercise intervention is personalised based on the individual's Activity Measure for Post-Acute-Care outpatient basic mobility score, and incorporates four exercise modes: mobility, callisthenics, aerobic and resistance. Exercise is implemented by physical therapists at study visits from presurgery until 6 months postsurgery. The primary endpoint is the level of physical function assessed by 6 min walk distance at 2 months postsurgery. Secondary outcomes include patient-reported outcomes (eg, quality of life, fatigue and self-efficacy) and other clinical outcomes, including length of stay, complications, readmission, pulmonary function and treatment-related costs up to 6 months postsurgery. ETHICS/DISSEMINATION The PEP study will test the clinical effectiveness and feasibility of a personalised exercise intervention in patients with lung cancer undergoing surgery. Outcomes of this clinical trial will be presented at national and international conferences and symposia and will be published in international, peer-reviewed journals. Ethics approval was obtained at the University of Utah (IRB 00104671). TRIAL REGISTRATION NUMBER NCT03306992.
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Affiliation(s)
- Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Caroline Himbert
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Kenneth Boucher
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - David W Wetter
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
- Division of General Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jaewhan Kim
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Kelly Lundberg
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer A Ligibel
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher A Barnes
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | | | - Robin Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | | | - Paul C LaStayo
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Thomas K Varghese
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA
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Meghea CI, Brinzaniuc A, Sidor A, Chereches RM, Mihu D, Iuhas CI, Stamatian F, Caracostea G, Dascal MD, Foley K, Baban A, Voice TC, Blaga OM. A couples-focused intervention for smoking cessation during pregnancy: The study protocol of the Quit Together pilot randomized controlled trial. Tob Prev Cessat 2018; 4:17. [PMID: 30906906 PMCID: PMC6430127 DOI: 10.18332/tpc/89926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/24/2022]
Abstract
Tobacco smoking remains the leading global cause of preventable disease and death. Preconception and pregnancy smoking are high in Central and Eastern Europe. Quit Together is a partnership between a US university and a Romanian university, obstetrics and gynecology clinics in Romania, and other community partners in Romania. The objective of the Quit Together pilot study is to adapt, enhance and test the implementation feasibility and initial efficacy of an evidence-based pregnancy and postnatal couple intervention for smoking cessation in Romania. Quit Together builds on the Motivation and Problem Solving (MAPS) approach, enhanced by targeting the couples' smoking behavior and focusing on dyadic efficacy for smoking cessation. The study is an ongoing randomized controlled trial of 120 Romanian pregnant smokers and their partners. Participants are randomized to: 1) an intervention arm consisting, typically, of up to 8 prenatal and postnatal telephone counseling calls for the women and 4 for their partners, combining motivational strategies and problem-solving/coping skills to encourage the woman to quit smoking and the partner to support her decision; and 2) a control arm (usual care). The primary outcome is maternal biochemically verified smoking abstinence at 3 months postpartum. Quit Together has the potential to identify effective strategies to increase maternal smoking cessation during pregnancy and smoking abstinence after birth. If effective, Quit Together is expected to have a sustainable positive impact on the health of the child, mother and partner, and potentially reduced health system costs.
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Affiliation(s)
- Cristian I. Meghea
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Michigan, USA
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeșș-Bolyai University, Cluj-Napoca, Romania
| | - Alexandra Brinzaniuc
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeșș-Bolyai University, Cluj-Napoca, Romania
| | - Alexandra Sidor
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeșș-Bolyai University, Cluj-Napoca, Romania
| | - Razvan M. Chereches
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeșș-Bolyai University, Cluj-Napoca, Romania
| | - Dan Mihu
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Obstetrics and Gynaecology Dominic Stanca Clinic, Cluj-Napoca, Romania
| | - Cristian I. Iuhas
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Obstetrics and Gynaecology Dominic Stanca Clinic, Cluj-Napoca, Romania
| | - Florin Stamatian
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Obstetrics and Gynaecology Clinic I, Cluj-Napoca, Romania
| | - Gabriela Caracostea
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Obstetrics and Gynaecology Clinic I, Cluj-Napoca, Romania
| | - Marina D. Dascal
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeșș-Bolyai University, Cluj-Napoca, Romania
| | - Kristie Foley
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University, North Carolina, USA
| | - Adriana Baban
- Department of Psychology, Babeșș-Bolyai University, Cluj-Napoca, Romania
| | - Thomas C. Voice
- Department of Civil and Environmental Engineering, College of Engineering, Michigan State University, Michigan, USA
| | - Oana M. Blaga
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeșș-Bolyai University, Cluj-Napoca, Romania
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Forray A, Gilstad-Hayden K, Suppies C, Bogen D, Sofuoglu M, Yonkers KA. Progesterone for smoking relapse prevention following delivery: A pilot, randomized, double-blind study. Psychoneuroendocrinology 2017; 86:96-103. [PMID: 28926762 PMCID: PMC5659923 DOI: 10.1016/j.psyneuen.2017.09.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/24/2017] [Accepted: 09/06/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Close to half of women who were smokers prior to conception quit smoking in pregnancy, when endogenous progesterone levels are high. However, at least half resume pre-pregnancy smoking levels within weeks after delivery and when progesterone levels drop. The current pilot study tested the feasibility and preliminary efficacy of postpartum progesterone replacement in preventing relapse to smoking in postpartum women with a history of pre-pregnancy smoking. METHODS This was an 8-week, double-blind, parallel, randomized, placebo-controlled pilot trial of 41 women with a history of pre-pregnancy smoking who achieved abstinence by 32 weeks of gestation. Immediately following delivery women were randomized to oral micronized progesterone (200mg twice daily) or placebo via computerized urn randomization program. The main outcome measures were descriptions of study feasibility: recruitment and retention. Secondary outcomes were 7-day point prevalence of abstinence at week 8, time to relapse and smoking cravings. RESULTS The trial was feasible with adequate randomization, 64% (41/64) of eligible women, and trial retention, 78% (32/41) completed the trial. Women taking progesterone were 1.8 times more likely to be abstinent during week 8 and took longer to relapse (10 vs. 4 weeks) compared to the placebo group, although these differences did not reach statistical significance. After adjusting for age and pre-quit smoking level, the number needed to treat was 7. There was a 10% greater decline per week in craving ratings in the progesterone group compared to placebo (β=-0.10, 95% CI: -0.15, -0.04, p<0.01). No serious adverse events occurred during the trial. CONCLUSIONS These preliminary findings support the promise of progesterone treatment in postpartum smokers and could constitute a therapeutic breakthrough.If these preliminary findings can be evaluated and replicated in a larger study with sufficient power, this may constitute an acceptable and safe smoking relapse prevention strategy for use during lactation.
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Affiliation(s)
- Ariadna Forray
- Department of Psychiatry, Yale School of Medicine,40 Temple Street, Suite 6B, New Haven, CT, 06510, United States.
| | - Kathryn Gilstad-Hayden
- Department of Psychiatry, Yale School of Medicine,40 Temple Street, Suite 6B, New Haven, CT, 06510, United States
| | - Cristine Suppies
- Department of Psychiatry, Yale School of Medicine,40 Temple Street, Suite 6B, New Haven, CT, 06510, United States
| | - Debra Bogen
- Department of Pediatrics, University of Pittsburgh School of Medicine, 3420 Fifth Avenue, Pittsburgh, PA, 15213, United States
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale School of Medicine,40 Temple Street, Suite 6B, New Haven, CT, 06510, United States; VA Connecticut Healthcare System, Building 35, 950 Campbell Avenue, West Haven, CT, 06516, United States
| | - Kimberly A Yonkers
- Department of Psychiatry, Yale School of Medicine,40 Temple Street, Suite 6B, New Haven, CT, 06510, United States; Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine,20 York Street, New Haven, CT, 06510, United States
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Orton S, Coleman T, Coleman-Haynes T, Ussher M. Predictors of Postpartum Return to Smoking: A Systematic Review. Nicotine Tob Res 2017; 20:665-673. [DOI: 10.1093/ntr/ntx163] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/19/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Sophie Orton
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Tom Coleman-Haynes
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Population Health Research Institute, St. Georges, University of London, London, UK
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Chamberlain C, O'Mara‐Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2017; 2:CD001055. [PMID: 28196405 PMCID: PMC6472671 DOI: 10.1002/14651858.cd001055.pub5] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors. SELECTION CRITERIA Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, with meta-regression conducted in STATA 14. MAIN RESULTS The overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.In separate comparisons, there is high-quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small.Evidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention.There was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20).High-quality evidence suggests incentive-based interventions are effective when compared with an alternative (non-contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I2 = 93%).High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health.The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32).Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions.The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions. AUTHORS' CONCLUSIONS Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update.
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Affiliation(s)
- Catherine Chamberlain
- La Trobe UniversityJudith Lumley Centre251 Faraday StreetMelbourneVicAustralia3000
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - Alison O'Mara‐Eves
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Jessie Porter
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
| | - Tim Coleman
- University of NottinghamDivision of Primary CareD1411, Medical SchoolQueen's Medical CentreNottinghamUKNG7 2UH
| | - Susan M Perlen
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Joanne E McKenzie
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
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Correa-Fernández V, Díaz-Toro EC, Reitzel LR, Guo L, Chen M, Li Y, Calo WA, Shih YCT, Wetter DW. Combined treatment for at-risk drinking and smoking cessation among Puerto Ricans: A randomized clinical trial. Addict Behav 2017; 65:185-192. [PMID: 27825036 PMCID: PMC5358923 DOI: 10.1016/j.addbeh.2016.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/29/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Abstract
Tobacco and alcohol use are linked behaviors that individually and synergistically increase the risk for negative health consequences. This study was a two-group, randomized clinical trial evaluating the efficacy of a behavioral intervention, "Motivation And Problem Solving Plus" (MAPS+), designed to concurrently address smoking cessation and the reduction of at-risk drinking. Targeted interventions may promote coaction, the likelihood that changing one behavior (smoking) increases the probability of changing another behavior (alcohol use). Puerto Ricans (N=202) who were smokers and at-risk drinkers were randomized to standard MAPS treatment focused exclusively on smoking cessation (S-MAPS), or MAPS+, focused on cessation and at-risk drinking reduction. Drinking outcomes included: number of at-risk drinking behaviors, heavy drinking, binge drinking, and drinking and driving. MAPS+ did not have a significant main effect on reducing at-risk drinking relative to S-MAPS. Among individuals who quit smoking, MAPS+ reduced the number of drinking behaviors, the likelihood of meeting criteria for heavy drinking relative to S-MAPS, and appeared promising for reducing binge drinking. MAPS+ did not improve drinking outcomes among individuals who were unsuccessful at quitting smoking. MAPS+ showed promise in reducing at-risk drinking among Puerto Rican smokers who successfully quit smoking, consistent with treatment enhanced coaction. Integrating an alcohol intervention into cessation treatment did not reduce engagement in treatment, or hinder cessation outcomes, and positively impacted at-risk drinking among individuals who quit smoking. Findings of coaction between smoking and drinking speak to the promise of multiple health behavior change interventions for substance use treatment and chronic disease prevention.
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Affiliation(s)
- Virmarie Correa-Fernández
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, United States.
| | - Elba C Díaz-Toro
- Division of Cancer Control and Population Sciences, University of Puerto Rico, Comprehensive Cancer Center, PMB 371, PO Box 70344, San Juan, PR 00936-8344, Puerto Rico.
| | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, United States.
| | - Lin Guo
- Department of Psychology, Rice University, 6500 Main St, Bioscience Research Collaborative, Houston, TX 77030, United States.
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Unit 1411, P.O. Box 301402, Houston, TX 77230, United States.
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Unit 1411, P.O. Box 301402, Houston, TX 77230, United States.
| | - William A Calo
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1102-F McGavran-Greenberg Bldg, CB 7411, Chapel Hill, NC 27599-7411, United States.
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Unit 1444, P.O. Box 301402, Houston, TX 77230, United States.
| | - David W Wetter
- Department of Population Health Sciences and The Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84108, United States.
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Strong LL, Hoover DS, Heredia NI, Krasny S, Spears CA, Correa-Fernández V, Wetter DW, Fernandez ME. Perspectives of Mexican-origin smokers on healthy eating and physical activity. HEALTH EDUCATION RESEARCH 2016; 31:465-77. [PMID: 27240536 PMCID: PMC4945857 DOI: 10.1093/her/cyw026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/29/2016] [Indexed: 05/04/2023]
Abstract
Key modifiable risk behaviors such as smoking, poor diet and physical inactivity often cluster and may have multiplicative adverse effects on health. This study investigated barriers and facilitators to healthy eating and physical activity (PA) in overweight Mexican-origin smokers to inform the adaptation of an evidence-based smoking cessation program into a multiple health behavior change intervention. Five focus groups were conducted with overweight Mexican-origin men (n = 9) and women (n = 21) who smoked. Barriers and facilitators of healthy eating and PA were identified, and gender differences were assessed. Participants expressed some motivation to eat healthfully and identified strategies for doing so, yet many women experienced difficulties related to personal, family and work-related circumstances. Barriers to healthy eating among men were related to food preferences and lack of familiarity with fruits and vegetables. Participants performed PA primarily within the context of work and domestic responsibilities. Stress/depressed mood, lack of motivation and concern for physical well-being limited further PA engagement. Routines involving eating, PA and smoking highlight how these behaviors may be intertwined. Findings emphasize the importance of social, structural and cultural contexts and call for additional investigation into how to integrate healthy eating and PA into smoking cessation interventions for overweight Mexican-origin smokers.
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Affiliation(s)
- Larkin L Strong
- Department of Health Disparities Research, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Diana S Hoover
- Department of Health Disparities Research, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Natalia I Heredia
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health and the Center for Health Promotion and Prevention Research, Houston, TX 77030, USA
| | - Sarah Krasny
- School of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Claire A Spears
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA
| | - David W Wetter
- Department of Psychology, Rice University, Houston, TX 77005, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health and the Center for Health Promotion and Prevention Research, Houston, TX 77030, USA
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Abstract
Prenatal substance use is a critical public health concern that is linked with several harmful maternal and fetal consequences. The most frequently used substance in pregnancy is tobacco, followed by alcohol, cannabis and other illicit substances. Unfortunately, polysubstance use in pregnancy is common, as well as psychiatric comorbidity, environmental stressors, and limited and disrupted parental care, all of which can compound deleterious maternal and fetal outcomes. There are few existing treatments for prenatal substance use and these mainly comprise behavioral and psychosocial interventions. Contingency management has been shown to be the most efficacious of these. The purpose of this review is to examine the recent literature on the prenatal use of tobacco, alcohol, cannabis, stimulants, and opioids, including the effects of these on maternal and fetal health and the current therapeutic options.
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Affiliation(s)
- Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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30
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Pollak KI, Fish LJ, Lyna P, Peterson BL, Myers ER, Gao X, Swamy GK, Brown-Johnson A, Whitecar P, Bilheimer AK, Pletsch PK. Efficacy of a Nurse-Delivered Intervention to Prevent and Delay Postpartum Return to Smoking: The Quit for Two Trial. Nicotine Tob Res 2016; 18:1960-6. [PMID: 27091830 DOI: 10.1093/ntr/ntw108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/08/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (eg, had strong intentions to return). METHODS We recruited 382 English-speaking spontaneous pregnant quitters from 14 prenatal clinics and randomized them to receive either a smoking abstinence booklet plus newsletters about parenting and stress (control) or a nurse-delivered smoking abstinence intervention that differed in intensity for the high and low risk groups. Our primary outcome was smoking abstinence at 12 months postpartum. RESULTS Using intent-to-treat analyses, there was a high rate of biochemically validated smoking abstinence at 12 months postpartum but no arm differences ( CONTROL 36% [95% confidence interval [CI]: 29-43] vs. INTERVENTION 35% [95% CI: 28-43], P = .81). Among women at low risk of returning to smoking, the crude abstinence rate was significantly higher in the control arm (46%) than in the intervention arm (33%); among women at high risk of returning to smoking, the crude abstinence rate was slightly lower but not different in the control arm (31%) than in the intervention arm (37%). CONCLUSIONS Low-risk women fared better with a minimal intervention that focused on parenting skills and stress than when they received an intensive smoking abstinence intervention. The opposite was true for women who were at high risk of returning to smoking. Clinicians might need to tailor their approach based on whether women are at high or low risk of returning to smoking. IMPLICATIONS Results suggest that high-risk and low-risk women might benefit from different types of smoking relapse interventions. Those who are lower risk of returning to smoking might benefit from stress reduction that is devoid of smoking content, whereas those who are higher risk might benefit from smoking relapse prevention.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC; Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC;
| | - Laura J Fish
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | | | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Angela Brown-Johnson
- Department of Obstetrics and Gynecology, Womack Army Medical Center, Ft Bragg, NC
| | - Paul Whitecar
- Department of Obstetrics and Gynecology, Womack Army Medical Center, Ft Bragg, NC
| | - Alicia K Bilheimer
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
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Levine MD, Cheng Y, Marcus MD, Kalarchian MA, Emery RL. Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial. JAMA Intern Med 2016; 176:443-52. [PMID: 26998789 PMCID: PMC7333234 DOI: 10.1001/jamainternmed.2016.0248] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Most women who quit smoking during pregnancy will relapse postpartum. Previous efforts to prevent postpartum relapse have been unsuccessful at increasing rates of sustained abstinence. OBJECTIVE To evaluate the relative efficacy of 2 different approaches to prevent postpartum smoking relapse. DESIGN, SETTING, AND PARTICIPANTS Pregnant women who recently had quit smoking were recruited before the end of pregnancy. Intervention sessions were conducted through a combination of telephone calls and in-person visits beginning at delivery and continuing through 24 weeks postpartum. Participants completed assessments at the prenatal baseline and at 12, 24, and 52 weeks postpartum. Participants were recruited between March 2008 and December 2012. The dates of the analysis were April 2014 to February 2015. INTERVENTIONS Women received postpartum-adapted, behavioral smoking relapse prevention intervention and were randomly assigned to an enhanced cognitive behavioral intervention that included additional specialized strategies and content focused on women's postpartum concerns about mood, stress, and weight (Strategies to Avoid Returning to Smoking [STARTS]) or a supportive, time and attention-controlled comparison (SUPPORT). Intervention began before delivery and continued through 24 weeks postpartum. MAIN OUTCOMES AND MEASURES The primary outcome was biochemically confirmed sustained tobacco abstinence at 52 weeks postpartum. Secondary outcomes were self-reported mood, levels of perceived stress, and degree of concern about smoking-related weight gain. RESULTS The study cohort comprised 300 participants (150 randomly assigned to each group). Their mean (SD) age was 24.99 (5.65) years. Overall, 38.0% (114 of 300), 33.7% (101 of 300), and 24.0% (72 of 300) of the sample maintained abstinence at 12, 24, and 52 weeks' postpartum, respectively. There were no differences between the intervention groups in abstinence or time to relapse. Self-reported depressive symptoms and perceived stress significantly improved over time, and improvements were similar for both intervention groups. Women with more depressive symptoms and higher levels of perceived stress were more likely to relapse (hazard ratio, 1.02; 95% CI, 1.00-1.04; P = .04 for depressive symptoms and hazard ratio, 1.04; 95% CI, 1.01-1.07; P = .003 for stress). CONCLUSIONS AND RELEVANCE An intervention designed to address women's concerns about mood, stress, and weight did not differentially improve rates of sustained tobacco abstinence postpartum compared with a time and attention-controlled comparison. Women in STARTS and SUPPORT reported postpartum improvements in mood and stress, and the experience of fewer depressive symptoms and less perceived stress was related to sustained abstinence. Given that most pregnant quitters will relapse within 1 year postpartum and that postpartum smoking has negative health consequences for women and children, effective interventions that target postpartum mood and stress are needed. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00757068.
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Affiliation(s)
- Michele D Levine
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yu Cheng
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania2Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania3Department of Psychiatry, University of Pitt
| | - Marsha D Marcus
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa A Kalarchian
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania4Duquesne University School of Nursing, Pittsburgh, Pennsylvania
| | - Rebecca L Emery
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Emery RL, Gregory MP, Grace JL, Levine MD. Prevalence and correlates of a lifetime cannabis use disorder among pregnant former tobacco smokers. Addict Behav 2016; 54:52-8. [PMID: 26717552 DOI: 10.1016/j.addbeh.2015.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/07/2015] [Accepted: 12/12/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Following tobacco and alcohol, cannabis is the most commonly used substance during pregnancy. Given the high prevalence of concurrent cannabis and tobacco use as well as the health consequences associated with prenatal substance use, we sought to document the relative contributions of psychosocial and psychiatric factors commonly associated with cannabis use in predicting a lifetime cannabis use disorder (CUD) among women who had quit smoking tobacco as a result of pregnancy. METHODS Pregnant former tobacco smokers (n=273) enrolled in a larger randomized controlled trial for postpartum tobacco relapse prevention completed semi-structured psychiatric interviews and self-reported demographic, pregnancy, health, psychosocial, and tobacco use factors during their third trimester of pregnancy. RESULTS In total, 14% (n=38) of women met criteria for a lifetime CUD. The strongest predictors of a lifetime CUD were a history of having multiple psychiatric disorders (OR=36.44; 95% CI=5.03-264.27; p<0.001) followed by a lifetime alcohol use disorder (OR=3.54; 95% CI=1.27-9.87; p<0.05). In addition, more frequent attempts to quit smoking tobacco (OR=1.12; 95% CI=1.01-1.25; p<0.05) and lower self-efficacy about weight management after quitting smoking tobacco (OR=0.78; 95% CI=0.62-0.97; p<0.05) also were significantly associated with a lifetime CUD. CONCLUSIONS Women with a history of both cannabis and tobacco dependence may represent a subset of women who need more specialized treatment during the perinatal period to improve substance use outcomes.
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Affiliation(s)
- Rebecca L Emery
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Melissa P Gregory
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA; University of Pittsburgh, Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
| | - Jennifer L Grace
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Michele D Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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Thomas JL, Luo X, Bengtson J, Wang Q, Ghidei W, Nyman J, Lust K, An L, Wetter DW, Epstein L, Ahluwalia JS. Enhancing Quit & Win contests to improve cessation among college smokers: a randomized clinical trial. Addiction 2016; 111:331-9. [PMID: 26767340 PMCID: PMC4721252 DOI: 10.1111/add.13144] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/14/2015] [Accepted: 08/28/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Quit & Win contests (in which smokers pledge to quit smoking for a defined period in exchange for the chance to win a prize) may be well-suited for college smokers. We tested the effectiveness of multiple versus single Quit & Win contests and that of added counseling versus no counseling in smoking cessation. DESIGN A two-by-two, randomized controlled trial with 6-month follow-up. SETTING Nineteen institutions in Minnesota, Texas, Ohio and Wisconsin. PARTICIPANTS College student smokers (n = 1217) were randomized within site to four conditions: single (n = 306), multiple contests alone (n = 309), single contest plus counseling (n = 296) or multiple contests with counseling (n = 306). INTERVENTION Participants in the standard contest condition (T1 and T2) were asked to abstain from all tobacco products for a 30-day period; those with confirmed abstinence were eligible for a lottery-based prize. Participants assigned to the multiple contest conditions (T3 and T4) participated in the 30-day contest and were enrolled automatically into two additional contest periods with an escalating prize structure. Participants randomized into the counseling conditions (T2 and T4) received up to six telephone-administered Motivation and Problem Solving (MAPS) counseling sessions over the 12-week treatment period. MEASURES The primary outcome was biochemically verified 30-day point prevalence (PP) abstinence rate at 6 months. Secondary outcomes were the same abstinence at end of treatment (4 months) and a proxy measure of 6-month verified continuous abstinence rate. Outcomes were based on all participants randomized. FINDINGS We found no evidence of an interaction between number of contests and counseling. Abstinence rates for multiple (13.5%) and single (11.7%) contests were not significantly different at 6 months [odds ratio (OR) = 1.18, 95% confidence interval (CI) = 0.84-1.66]. The addition of counseling did not improve 6-month abstinence significantly (13.7 versus 11.6%, OR = 1.21, 95% CI = 0.86-1.70). Multiple contests increased abstinence at 4 months (19.3 versus 10.3%, OR = 2.09, 95% CI = 1.50-2.91) and continuous abstinence at 6 months (7.8 versus 3.8%, OR = 2.14, 95% CI = 1.28-3.56). CONCLUSION Multiple Quit & Win contests may increase smoking abstinence rates in college students more than single contests, but it is not clear whether adding counseling to these interventions produces any additional benefit.
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Affiliation(s)
- Janet L Thomas
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Xianghua Luo
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
- University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA
| | - Jill Bengtson
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Winta Ghidei
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - John Nyman
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Katherine Lust
- Boynton Health Service, University of Minnesota, Minneapolis, MN, USA
| | - Lawrence An
- Center for Health Communications Research, University of Michigan, Ann Arbor, MI, USA
| | - David W Wetter
- M. D. Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Leonard Epstein
- Pediatrics; Epidemiology and Environmental Health, University of Buffalo, Buffalo, NY, USA
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Abstract
Perinatal substance use remains a major public health problem and is associated with a number of deleterious maternal and fetal effects. Polysubstance use in pregnancy is common and can potentiate adverse maternal and fetal outcomes. Tobacco is the most commonly used substance in pregnancy, followed by alcohol and illicit substances. The treatments for perinatal substance use are limited and consist mostly of behavioral and psychosocial interventions. Of these, contingency management has shown the most efficacy. More recently, novel interventions such as progesterone for postpartum cocaine use have shown promise. The purpose of this review is to examine the recent literature on the use of tobacco, alcohol, cannabis, stimulants, and opioids in the perinatal period, their effects on maternal and fetal health, and current treatments.
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Affiliation(s)
- Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA.
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Lee M, Miller SM, Wen KY, Hui SKA, Roussi P, Hernandez E. Cognitive-behavioral intervention to promote smoking cessation for pregnant and postpartum inner city women. J Behav Med 2015; 38:932-43. [PMID: 26335312 DOI: 10.1007/s10865-015-9669-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
Abstract
This study evaluated a theory-guided cognitive-behavioral counseling (CBC) intervention for smoking cessation during pregnancy and postpartum. It also explored the mediating role of cognitive-affective variables on the impact of CBC. Underserved inner city pregnant women (N = 277) were randomized to the CBC or a best practice (BP) condition, each of which consisted of two prenatal and two postpartum sessions. Assessments were obtained at baseline, late pregnancy, and 1- and 5-months postpartum. An intent-to-treat analysis found no differences between the two groups in 7-day point-prevalence abstinence. However, a respondents-only analysis revealed a significantly higher cessation rate in the CBC (37.3 %) versus the BP (19.0 %) condition at 5-months postpartum follow-up. This effect was mediated by higher quitting self-efficacy and lower cons of quitting. CBC, based on the Cognitive-Social Health Information Processing model, has the potential to increase postpartum smoking abstinence by assessing and addressing cognitive-affective barriers among women who adhere to the intervention.
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Affiliation(s)
- Minsun Lee
- Department of Psychosocial and Behavioral Medicine Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Suzanne M Miller
- Department of Psychosocial and Behavioral Medicine Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
| | - Kuang-Yi Wen
- Department of Psychosocial and Behavioral Medicine Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Sui-kuen Azor Hui
- Department of Psychosocial and Behavioral Medicine Program, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Pagona Roussi
- Department of Psychology, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Enrique Hernandez
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
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Perinatal substance use: a prospective evaluation of abstinence and relapse. Drug Alcohol Depend 2015; 150:147-55. [PMID: 25772437 PMCID: PMC4387084 DOI: 10.1016/j.drugalcdep.2015.02.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 02/04/2015] [Accepted: 02/23/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Substance use decreases in pregnancy but little prospective data are available on the rates of abstinence and relapse for specific substances. This study compared rates of abstinence in pregnancy and relapse postpartum for nicotine cigarettes, alcohol, marijuana, and cocaine. METHODS Data from 152 women drawn from a randomized controlled trial comparing psychological treatments for substance use in pregnancy were analyzed. Self-reports of substance use and urine for toxicology testing throughout pregnancy and 3-months, 12-months and 24-months post-delivery were collected. Multivariate Cox models were used to compare rates of abstinence and relapse across substances. RESULTS In pregnancy, 83% of all women achieved abstinence to at least one substance. The mean (SE) days to abstinence was 145.81 (9.17), 132.01 (6.17), 151.52 (6.24), and 148.91 (7.68) for cigarettes, alcohol, marijuana and cocaine, respectively. Participants were more likely to achieve abstinence from alcohol (HR 7.24; 95% CI 4.47-11.72), marijuana (HR 4.06; 95% CI 1.87-6.22), and cocaine (HR 3.41; 95% CI 2.53-6.51), than cigarettes. Postpartum, 80% of women abstinent in the last month of pregnancy relapsed to at least one substance. The mean days to relapse was 109.67 (26.34), 127.73 (21.29), 138.35 (25.46), and 287.55 (95.85) for cigarettes, alcohol, marijuana and cocaine, respectively. Relapse to cocaine was only 34% (HR 0.34; 95% CI 0.15-0.77) that of cigarettes. CONCLUSIONS Pregnancy-related abstinence rates were high for all substances except cigarettes. Postpartum relapse was common, with cocaine using women being less likely to relapse after attaining abstinence compared to women using cigarettes, alcohol or marijuana.
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Meghea CI, Brînzaniuc A, Mihu D, Iuhas CI, Stamatian F, Caracostea G, Sidor A, Alexa PM, Brînza C, Pop OM, Cherecheș RM. A couple-focused intervention to prevent postnatal smoking relapse: PRISM study design. Contemp Clin Trials 2015; 41:273-9. [PMID: 25678316 DOI: 10.1016/j.cct.2015.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/31/2015] [Accepted: 02/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Maternal smoking is one of the most modifiable factors with clear adverse effects for the fetus and the entire family. Addressing the dearth of pregnancy smoking interventions with partner support, PRISM (Prevent Relapse In SMoking) is a partnership between a research institution and the two largest state-owned obstetrics and gynecology clinics in Cluj-Napoca, Romania. The study will assess the efficacy of a couple-focused telephone-counseling program to prevent smoking relapse among mothers who quit smoking closely before or during pregnancy. METHODS/DESIGN The intervention is a program for couples based on motivational interviewing delivered over the phone after birth. The study is an ongoing randomized controlled trial of 250 Romanian women recruited soon after childbirth, who quit smoking in the six months before pregnancy or no later than the end of the first pregnancy trimester and remained abstinent (which was biochemically verified) until delivery. Participants were randomized to: (1) a control arm (usual care); and (2) an intervention arm consisting of up to 4 postnatal counseling calls for mothers and their partners using motivational interviewing to encourage the woman to remain smoke-free and the partner to support her decision. The primary outcome is maternal smoking abstinence at 6 months postpartum (biochemically verified). DISCUSSION PRISM has the potential to identify strategies to reduce maternal postnatal relapse and increase partner quitting. If successful, the program may be an effective method to prevent and reduce smoking, which may lead to improved child, mother, and partner health both in the short and the long term.
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Affiliation(s)
- Cristian Ioan Meghea
- Institute for Health Policy, College of Human Medicine, Michigan State University, East Lansing, MI 48823 USA; Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, A630 East Fee Hall, East Lansing, MI 48823 USA; Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University Cluj-Napoca, 7 Pandurilor Street, 400376 Cluj-Napoca, Romania
| | - Alexandra Brînzaniuc
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University Cluj-Napoca, 7 Pandurilor Street, 400376 Cluj-Napoca, Romania
| | - Dan Mihu
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania, Department of Obstetrics and Gynaecology, "Dominic Stanca" Clinic, 55-57 21 Decembrie 1989 Street, 400124, Cluj-Napoca Romania
| | - Cristian Ioan Iuhas
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania, Department of Obstetrics and Gynaecology, "Dominic Stanca" Clinic, 55-57 21 Decembrie 1989 Street, 400124, Cluj-Napoca Romania
| | - Florin Stamatian
- Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania, Department of Gynaecology, Clinic I, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Gabriela Caracostea
- Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania, Department of Gynaecology, Clinic I, 3-5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Alexandra Sidor
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University Cluj-Napoca, 7 Pandurilor Street, 400376 Cluj-Napoca, Romania
| | - Paula Mădălina Alexa
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University Cluj-Napoca, 7 Pandurilor Street, 400376 Cluj-Napoca, Romania
| | - Cătălina Brînza
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University Cluj-Napoca, 7 Pandurilor Street, 400376 Cluj-Napoca, Romania
| | - Oana Maria Pop
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University Cluj-Napoca, 7 Pandurilor Street, 400376 Cluj-Napoca, Romania.
| | - Răzvan Mircea Cherecheș
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University Cluj-Napoca, 7 Pandurilor Street, 400376 Cluj-Napoca, Romania
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Wen KY, Miller SM, Roussi P, Belton TD, Baman J, Kilby L, Hernandez E. A content analysis of self-reported barriers and facilitators to preventing postpartum smoking relapse among a sample of current and former smokers in an underserved population. HEALTH EDUCATION RESEARCH 2015; 30:140-151. [PMID: 25099776 PMCID: PMC4296888 DOI: 10.1093/her/cyu048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 07/15/2014] [Indexed: 06/03/2023]
Abstract
To characterize the barriers and facilitators thatprevent postpartum relapse and maintain smoking abstinence among a socioeconomically underserved population, recruited through Philadelphia-area women, infants, and children clinics, in-person interviews were conducted with 30 women who had quit smoking for one or more pregnancies in the past 3 years to retrospectively describe their attempts to remain abstinent during the postpartum period. Responses were analysed using the constructs from the Cognitive-Social Health Information Processing model, which identifies the cognitive, affective and behavioral factors involved in goal-oriented self-regulatory actions, in the context of a vulnerable population of women. Motherhood demands were a significant source of relapse stress. Stresses associated with partner and family relationships also contributed to relapse. The presence of other smokers in the environment was mentioned by many women in our sample as affecting their ability to remain smoke-free postpartum. Participants reported four main strategies that helped them to successfully cope with postpartum cravings and relapses, including being informed of smoking risks, maintaining goal-oriented thoughts, focusing on their concerns about the baby's health and receiving positive social support from families and friends. Results provide guidance for the design of smoking relapse interventions that may address the unique stressors reported by underserved postpartum women.
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Affiliation(s)
- Kuang-Yi Wen
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Suzanne M Miller
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Pagona Roussi
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Tanisha D Belton
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Jayson Baman
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Linda Kilby
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Enrique Hernandez
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA, Philadelphia Women, Infants and Children Program, Philadelphia, PA, USA and Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA
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Castro Y, Fernández ME, Strong LL, Stewart DW, Krasny S, Hernandez Robles E, Heredia N, Spears CA, Correa-Fernández V, Eakin E, Resnicow K, Basen-Engquist K, Wetter DW. Adaptation of a counseling intervention to address multiple cancer risk factors among overweight/obese Latino smokers. HEALTH EDUCATION & BEHAVIOR 2015; 42:65-72. [PMID: 25527143 PMCID: PMC4467573 DOI: 10.1177/1090198114560019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
More than 60% of cancer-related deaths in the United States are attributable to tobacco use, poor nutrition, and physical inactivity, and these risk factors tend to cluster together. Thus, strategies for cancer risk reduction would benefit from addressing multiple health risk behaviors. We adapted an evidence-based intervention grounded in social cognitive theory and principles of motivational interviewing originally developed for smoking cessation to also address physical activity and fruit/vegetable consumption among Latinos exhibiting multiple health risk behaviors. Literature reviews, focus groups, expert consultation, pretesting, and pilot testing were used to inform adaptation decisions. We identified common mechanisms underlying change in smoking, physical activity, and diet used as treatment targets; identified practical models of patient-centered cross-cultural service provision; and identified that family preferences and support as particularly strong concerns among the priority population. Adaptations made to the original intervention are described. The current study is a practical example of how an intervention can be adapted to maximize relevance and acceptability and also maintain the core elements of the original evidence-based intervention. The intervention has significant potential to influence cancer prevention efforts among Latinos in the United States and is being evaluated in a sample of 400 Latino overweight/obese smokers.
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Affiliation(s)
| | | | - Larkin L Strong
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diana W Stewart
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah Krasny
- The University of Texas School of Public Health, Houston, TX, USA
| | | | - Natalia Heredia
- The University of Texas School of Public Health, Houston, TX, USA
| | | | | | - Elizabeth Eakin
- The University of Queensland, Brisbane, Queensland, Australia
| | - Ken Resnicow
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Su A, Buttenheim AM. Maintenance of smoking cessation in the postpartum period: which interventions work best in the long-term? Matern Child Health J 2015; 18:714-28. [PMID: 23812798 DOI: 10.1007/s10995-013-1298-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Smoking during pregnancy has been linked to a variety of adverse outcomes for both maternal and child health. Decades of studies have sought to increase cessation antepartum and reduce relapse postpartum. A number of effective interventions exist to significantly reduce smoking rates during pregnancy; however, less is known about how to prevent relapse in the postpartum period. This review investigates interventions to prevent relapse in the long-term postpartum period. We focus specifically on nonspontaneous quitters (individuals who quit smoking as a result of an external intervention) to reveal differences in long-term response to interventions for this population compared to spontaneous quitters. A systematic literature search yielded 32 relevant studies of pharmacological, behavioral, and incentives-based interventions. Results were compiled, analyzed, and compared in order to evaluate success factors in maintaining cessation postpartum. Though intervention groups showed consistently higher quit rates during pregnancy than control groups, none of the intervention types were effective at preventing relapse in the longer-term postpartum period. One study maintained significantly higher abstinence in the longer-term period postpartum using a mix of behavioral and incentives strategies. Additional research in this area is needed to identify optimal intervention strategies to reduce long-term postpartum relapse, particularly for nonspontaneous quitters.
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Affiliation(s)
- Anny Su
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA,
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Pollak KI, Fish LJ, Lyna P, Peterson BL, Swamy GK, Levine MD. Predictors of pregnant quitters' intention to return to smoking postpartum. Nicotine Tob Res 2014; 17:742-5. [PMID: 25542912 DOI: 10.1093/ntr/ntu270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/27/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Although many pregnant women quit smoking, most return to smoking postpartum. Returning to smoking is strongly related to women's stated intention about smoking during pregnancy. We examined factors related to women's intention to return to smoking to improve intervention trials. METHODS We report cross-sectional baseline data from a randomized controlled trial to prevent postpartum return to smoking. Women (n = 382; 98% consent rate) were English-speaking women who smoked at least 100 cigarettes in their lifetimes and at least 5 cigarettes a day prior to becoming pregnant. We fit logistic regression models to test whether women's intention to return to smoking was associated with demographic and smoking factors such as race, parity, and smoker self-identity. RESULTS Forty-three percent of women had a strong intention of returning to smoking. Factors independently associated with intending to return to smoking were: stating they did not want to be currently pregnant (OR = 2.1, CI = 1.1-3.9), reporting being abstinent for fewer days (OR = 0.8, CI = 0.7-0.9), being less concerned about the harmful effects of smoking to themselves (OR = 1.6, CI = 0.9-2.8), viewing quit as temporary (OR = 2.1, CI = 1.2-3.6), and self-identifying selves as smokers (OR = 8.7, CI = 5.0-15.2). CONCLUSIONS Although some factors related to intention to return to smoking were unchangeable, it might be possible to attempt to change women's attribution of why they quit to be more permanent and to have them change their self-identity to be a "nonsmoker" from a "smoker who is not currently smoking." Helping women have stronger intentions to stay quit could promote less return to smoking postpartum.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC; Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC;
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC; Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | - Bercedis L Peterson
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Michele D Levine
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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Bull ER, Dombrowski SU, McCleary N, Johnston M. Are interventions for low-income groups effective in changing healthy eating, physical activity and smoking behaviours? A systematic review and meta-analysis. BMJ Open 2014; 4:e006046. [PMID: 25432903 PMCID: PMC4248081 DOI: 10.1136/bmjopen-2014-006046] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/15/2014] [Accepted: 11/06/2014] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis examining the effectiveness of behavioural interventions targeting diet, physical activity or smoking in low-income adults. DESIGN Systematic review with random effects meta-analyses. Studies before 2006 were identified from a previously published systematic review (searching 1995-2006) with similar but broader inclusion criteria (including non-randomised controlled trials (RCTs)). Studies from 2006 to 2014 were identified from eight electronic databases using a similar search strategy. DATA SOURCES MEDLINE, EMBASE, PsycINFO, ASSIA, CINAHL, Cochrane Controlled Trials, Cochrane Systematic Review and DARE. ELIGIBILITY CRITERIA FOR SELECTING STUDIES RCTs and cluster RCTs published from 1995 to 2014; interventions targeting dietary, physical activity and smoking; low-income adults; reporting of behavioural outcomes. MAIN OUTCOME MEASURES Dietary, physical activity and smoking cessation behaviours. RESULTS 35 studies containing 45 interventions with 17,000 participants met inclusion criteria. At postintervention, effects were positive but small for diet (standardised mean difference (SMD) 0.22, 95% CI 0.14 to 0.29), physical activity (SMD 0.21, 95% CI 0.06 to 0.36) and smoking (relative risk (RR) of 1.59, 95% CI 1.34 to 1.89). Studies reporting follow-up results suggested that effects were maintained over time for diet (SMD 0.16, 95% CI 0.08 to 0.25) but not physical activity (SMD 0.17, 95% CI -0.02 to 0.37) or smoking (RR 1.11, 95% CI 0.93 to 1.34). CONCLUSIONS Behaviour change interventions for low-income groups had small positive effects on healthy eating, physical activity and smoking. Further work is needed to improve the effectiveness of behaviour change interventions for deprived populations.
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Affiliation(s)
| | - Stephan U Dombrowski
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK
| | - Nicola McCleary
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | - Marie Johnston
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
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Greaves L, Hemsing N, Poole N, Bialystok L, O’Leary R. From fetal health to women’s health: expanding the gaze on intervening on smoking during pregnancy. CRITICAL PUBLIC HEALTH 2014. [DOI: 10.1080/09581596.2014.968527] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fang ML, Gerbrandt J, Liwander A, Pederson A. Exploring promising gender-sensitive tobacco and alcohol use interventions: results of a scoping review. Subst Use Misuse 2014; 49:1400-16. [PMID: 24827863 DOI: 10.3109/10826084.2014.912225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This review examined the breadth of gender-sensitive tobacco and alcohol interventions that target girls and women. A comprehensive review of databases and websites was conducted in 2011/2012 for interventions that focused on girls and women health, incorporated an understanding of sex and/or gender, engaged with the determinants of women's health, and sought to reduce gender-related social and health inequities. Results of the review suggest that interventions designed with an understanding of the effect of gender roles, norms, and behaviors on women's health are limited and that much work remains to encourage practitioners to use a gender-sensitive approach when designing interventions.
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Affiliation(s)
- Mei Lan Fang
- British Columbia Centre of Excellence for Women's Health, Vancouver, British Columbia, Canada
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Bryant J, Passey ME, Hall AE, Sanson-Fisher RW. A systematic review of the quality of reporting in published smoking cessation trials for pregnant women: an explanation for the evidence-practice gap? Implement Sci 2014; 9:94. [PMID: 25138616 PMCID: PMC4147164 DOI: 10.1186/s13012-014-0094-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 07/05/2014] [Indexed: 12/01/2022] Open
Abstract
Background To facilitate translation of evidence into clinical practice, it is critical that clear, specific, and detailed information about interventions is provided in publications to promote replication, appropriate aggregation in meta-analysis, and implementation. This study examined whether twenty elements of interventions deemed essential for such translational application were reported in sufficient detail in smoking cessation trials with pregnant women. Methods Searches of electronic databases using MeSH terms and keywords identified peer-reviewed English language studies published between 2001 and 2012. Eligible studies reported a smoking cessation intervention targeted at pregnant women and met Cochrane’s Effective Practice and Organization of Care group study design criteria. Each intervention arm of eligible studies was assessed against the developed twenty criteria. Results Thirty relevant studies reported the findings of 45 intervention arms. The mode of delivery of the intervention was reported in 100% of intervention arms. Other well-reported criteria included reporting of the provider who delivered the intervention (96%), sample characteristics (80%), and the intervention setting (80%). Criteria not reported adequately included care provided to women who relapse (96% not reported), details about training given to providers (77% not reported), and the method of quit advice advised (76% not reported). No studies reported 100% of relevant criteria. Conclusions Current standards of reporting of intervention content and implementation are suboptimal. The use of smoking cessation specific checklists for reporting of trials, standard reporting using behaviour change taxonomies, and the publication of protocols as supplements should be considered as ways of improving the specificity of reporting. Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0094-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan 2308, NSW, Australia.
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Constantine NA, Slater JK, Carroll JA, Antin TMJ. Smoking cessation, maintenance, and relapse experiences among pregnant and postpartum adolescents: a qualitative analysis. J Adolesc Health 2014; 55:216-21. [PMID: 24566100 DOI: 10.1016/j.jadohealth.2013.12.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 12/20/2013] [Accepted: 12/24/2013] [Indexed: 01/23/2023]
Abstract
PURPOSE To understand the experiences and processes of smoking cessation, maintenance, and relapse for pregnant and postpartum adolescents, whose perspectives and needs might be different from other age groups. METHODS We conducted in-depth semistructured interviews with 52 pregnant and postpartum adolescents using tools of grounded theory analysis. RESULTS Spontaneous smoking cessation during pregnancy was reported by most participants. This was generally explained as resulting from knowledge about the harmful effects of tobacco on the fetus, intense emotional reactions to this knowledge, or unpleasant tobacco- and pregnancy-related physical symptoms. Relapses were common, however. Most participants experienced guilt when they relapsed during pregnancy. Postpartum relapse was less fraught, as many participants no longer considered their smoking to negatively affect their infants. This was found even among adolescents who were breastfeeding. Participants who did maintain cessation postpartum typically reported support from smoke-free families and environments. CONCLUSIONS The results of this study suggest a constellation of protective factors that contribute to smoking cessation and maintenance during and after pregnancy, as well as risk factors that contribute to temporary or permanent relapses. These results can inform future research and interventions on tobacco prevention among pregnant and postpartum adolescents. Several promising strategies for intervention development are discussed.
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Affiliation(s)
- Norman A Constantine
- Center for Research on Adolescent Health and Development, Public Health Institute, Oakland, California; School of Public Health, University of California, Berkeley, California.
| | - Jana Kay Slater
- Samaritan Health Services, Center for Health Research and Quality, Corvallis, Oregon
| | - Julie A Carroll
- Department of Psychology, Emory University, Atlanta, Georgia
| | - Tamar M J Antin
- Center for Research on Adolescent Health and Development, Public Health Institute, Oakland, California
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Cervical cancer control for Hispanic women in Texas: strategies from research and practice. Gynecol Oncol 2014; 132 Suppl 1:S26-32. [PMID: 24398135 DOI: 10.1016/j.ygyno.2013.12.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/19/2013] [Accepted: 12/27/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Hispanic women in Texas have among the highest rates of cervical cancer incidence and mortality in the country. Increasing regular Papanicolaou test screening and HPV vaccination are crucial to reduce the burden of cervical cancer among Hispanics. This paper presents lessons learned from community-based cervical cancer control programs for Hispanics and highlights effective intervention programs, methods and strategies. METHODS We reviewed and summarized cervical cancer control efforts targeting Hispanic women, focusing on interventions developed by researchers at the University of Texas, School of Public Health. We identified commonalities across programs, highlighted effective methods, and summarized lessons learned to help guide future intervention efforts. RESULTS Community-academic partnerships were fundamental in all steps of program development and implementation. Programs reviewed addressed psychosocial, cultural, and access barriers to cervical cancer control among low-income Hispanic women. Intervention approaches included lay health worker (LHW) and navigation models and used print media, interactive tailored media, photonovellas, client reminders, one-on-one and group education sessions. CONCLUSIONS Small media materials combined with LHW and navigation approaches were effective in delivering Pap test screening and HPV vaccination messages and in linking women to services. Common theoretical methods included in these approaches were modeling, verbal persuasion, and facilitating access. Adaptation of programs to an urban environment revealed that intensive navigation was needed to link women with multiple access barriers to health services. Collectively, this review reveals 1) the importance of using a systematic approach for planning and adapting cervical cancer control programs; 2) advantages of collaborative academic-community partnerships to develop feasible interventions with broad reach; 3) the use of small media and LHW approaches and the need for tailored phone navigation in urban settings; and 4) coordination and technical assistance of community-based efforts as a way to maximize resources.
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Vidrine JI, Reitzel LR, Figueroa PY, Velasquez MM, Mazas CA, Cinciripini PM, Wetter DW. Motivation and Problem Solving (MAPS): Motivationally Based Skills Training for Treating Substance Use. COGNITIVE AND BEHAVIORAL PRACTICE 2013; 20:501-516. [PMID: 33239855 PMCID: PMC7685295 DOI: 10.1016/j.cbpra.2011.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Over 10 years ago, Baer and colleagues proposed the integration of skills training and motivational strategies for the treatment of substance abuse. Since that time, several studies evaluating the efficacy of such hybrid approaches have been published, but few have been efficacious. Motivation and Problem Solving (MAPS) is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory-based treatment strategies within an overarching motivational framework, and has been demonstrated to be effective in a randomized clinical trial focused on the prevention of postpartum smoking relapse. MAPS was designed to be applicable to not only relapse prevention but also the cessation of substance use, and is relevant for individuals regardless of their motivation to change. MAPS views motivation as dynamically fluctuating from moment to moment throughout the behavior change process, and comprehensively addresses multiple issues important to the individual and relevant to change through the creation of a wellness program. As a result, we believe that MAPS enhances the likelihood that individuals will successfully achieve and maintain abstinence from substance use, and that its comprehensive focus on addressing diverse and salient issues enhances both engagement in treatment and its applicability in modifying other health risk behaviors. The current paper introduces MAPS, distinguishes it from other hybrid and stage-based substance use treatments, and provides detailed information and clinical text regarding how MAPS is specifically and uniquely implemented to address key mechanisms relevant to quitting smoking and maintaining abstinence.
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Chamberlain C, O’Mara-Eves A, Oliver S, Caird JR, Perlen SM, Eades SJ, Thomas J. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2013; 10:CD001055. [PMID: 24154953 PMCID: PMC4022453 DOI: 10.1002/14651858.cd001055.pub4] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, stillbirth, low birthweight and preterm birth and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and increasing in low- to middle-income countries. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS In this fifth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 March 2013), checked reference lists of retrieved studies and contacted trial authors to locate additional unpublished data. SELECTION CRITERIA Randomised controlled trials, cluster-randomised trials, randomised cross-over trials, and quasi-randomised controlled trials (with allocation by maternal birth date or hospital record number) of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, and subgroup analyses and sensitivity analysis were conducted in SPSS. MAIN RESULTS Eighty-six trials were included in this updated review, with 77 trials (involving over 29,000 women) providing data on smoking abstinence in late pregnancy.In separate comparisons, counselling interventions demonstrated a significant effect compared with usual care (27 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.75), and a borderline effect compared with less intensive interventions (16 studies; average RR 1.35, 95% CI 1.00 to 1.82). However, a significant effect was only seen in subsets where counselling was provided in conjunction with other strategies. It was unclear whether any type of counselling strategy is more effective than others (one study; RR 1.15, 95% CI 0.86 to 1.53). In studies comparing counselling and usual care (the largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy (eight studies; average RR 1.06, 95% CI 0.93 to 1.21). However, a clear effect was seen in smoking abstinence at zero to five months postpartum (10 studies; average RR 1.76, 95% CI 1.05 to 2.95), a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77), and a significant effect at 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), but not in the longer term. In other comparisons, the effect was not significantly different from the null effect for most secondary outcomes, but sample sizes were small.Incentive-based interventions had the largest effect size compared with a less intensive intervention (one study; RR 3.64, 95% CI 1.84 to 7.23) and an alternative intervention (one study; RR 4.05, 95% CI 1.48 to 11.11).Feedback interventions demonstrated a significant effect only when compared with usual care and provided in conjunction with other strategies, such as counselling (two studies; average RR 4.39, 95% CI 1.89 to 10.21), but the effect was unclear when compared with a less intensive intervention (two studies; average RR 1.19, 95% CI 0.45 to 3.12).The effect of health education was unclear when compared with usual care (three studies; average RR 1.51, 95% CI 0.64 to 3.59) or less intensive interventions (two studies; average RR 1.50, 95% CI 0.97 to 2.31).Social support interventions appeared effective when provided by peers (five studies; average RR 1.49, 95% CI 1.01 to 2.19), but the effect was unclear in a single trial of support provided by partners.The effects were mixed where the smoking interventions were provided as part of broader interventions to improve maternal health, rather than targeted smoking cessation interventions.Subgroup analyses on primary outcome for all studies showed the intensity of interventions and comparisons has increased over time, with higher intensity interventions more likely to have higher intensity comparisons. While there was no significant difference, trials where the comparison group received usual care had the largest pooled effect size (37 studies; average RR 1.34, 95% CI 1.25 to 1.44), with lower effect sizes when the comparison group received less intensive interventions (30 studies; average RR 1.20, 95% CI 1.08 to 1.31), or alternative interventions (two studies; average RR 1.26, 95% CI 0.98 to 1.53). More recent studies included in this update had a lower effect size (20 studies; average RR 1.26, 95% CI 1.00 to 1.59), I(2)= 3%, compared to those in the previous version of the review (50 studies; average RR 1.50, 95% CI 1.30 to 1.73). There were similar effect sizes in trials with biochemically validated smoking abstinence (49 studies; average RR 1.43, 95% CI 1.22 to 1.67) and those with self-reported abstinence (20 studies; average RR 1.48, 95% CI 1.17 to 1.87). There was no significant difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however the effect was unclear in three dissemination trials of counselling interventions where the focus on the intervention was at an organisational level (average RR 0.96, 95% CI 0.37 to 2.50). The pooled effects were similar in interventions provided for women with predominantly low socio-economic status (44 studies; average RR 1.41, 95% CI 1.19 to 1.66), compared to other women (26 studies; average RR 1.47, 95% CI 1.21 to 1.79); though the effect was unclear in interventions among women from ethnic minority groups (five studies; average RR 1.08, 95% CI 0.83 to 1.40) and aboriginal women (two studies; average RR 0.40, 95% CI 0.06 to 2.67). Importantly, pooled results demonstrated that women who received psychosocial interventions had an 18% reduction in preterm births (14 studies; average RR 0.82, 95% CI 0.70 to 0.96), and infants born with low birthweight (14 studies; average RR 0.82, 95% CI 0.71 to 0.94). There did not appear to be any adverse effects from the psychosocial interventions, and three studies measured an improvement in women's psychological wellbeing. AUTHORS' CONCLUSIONS Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy, and reduce low birthweight and preterm births.
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Affiliation(s)
- Catherine Chamberlain
- Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alison O’Mara-Eves
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Jenny R Caird
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Susan M Perlen
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Sandra J Eades
- School of Public Health, Sydney School of Medicine, University of Sydney, Sydney, Australia
| | - James Thomas
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
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van der Meer RM, Willemsen MC, Smit F, Cuijpers P. Smoking cessation interventions for smokers with current or past depression. Cochrane Database Syst Rev 2013:CD006102. [PMID: 23963776 DOI: 10.1002/14651858.cd006102.pub2] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Individuals with current or past depression are often smokers who are more nicotine dependent, more likely to suffer from negative mood changes after nicotine withdrawal, and more likely to relapse to smoking after quitting than the general population, which contributes to their higher morbidity and mortality from smoking-related illnesses. It remains unclear what interventions can help them to quit smoking. OBJECTIVES To evaluate the effectiveness of smoking cessation interventions, with and without specific mood management components, in smokers with current or past depression. SEARCH METHODS In April 2013, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, other reviews, and asked experts for information on trials. SELECTION CRITERIA Criteria for including studies in this review were that they had to be randomised controlled trials (RCTs) comparing smoking cessation interventions in adult smokers with current or past depression. Depression was defined as major depression or depressive symptoms. We included studies where subgroups of participants with depression were identified, either pre-stated or post hoc. The outcome was abstinence from smoking after six months or longer follow-up. We preferred prolonged or continuous abstinence and biochemically validated abstinence where available. DATA COLLECTION AND ANALYSIS When possible, we estimated pooled risk ratios (RRs) with the Mantel-Haenszel method (fixed-effect model). We also performed subgroup analyses, by length of follow-up, depression measurement, depression group in study, antidepressant use, published or unpublished data, format of intervention, level of behavioural support, additional pharmacotherapy, type of antidepressant medication, and additional nicotine replacement therapy (NRT). MAIN RESULTS Forty-nine RCTs were included of which 33 trials investigated smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta-analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (11 trials, N = 1844, RR 1.47, 95% CI 1.13 to 1.92). In smokers with past depression we found a similar effect (13 trials, N = 1496, RR 1.41, 95% CI 1.13 to 1.77). Meta-analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (5 trials, N = 410, RR 1.37, 95% CI 0.83 to 2.27). There were not enough trial data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression. Bupropion (4 trials, N = 404, RR 2.04, 95% CI 1.31 to 3.18) might significantly increase long-term cessation among smokers with past depression when compared with placebo, but the evidence for bupropion is relatively weak due to the small number of studies and the post hoc subgroups for all the studies. There were not enough trial data to evaluate the effectiveness of fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression.Twenty-three of the 49 trials investigated smoking cessation interventions without specific components for depression. There was heterogeneity between the trials which compared psychosocial interventions with standard smoking cessation counselling for both smokers with current and past depression. Therefore, we did not estimate a pooled effect. One trial compared nicotine replacement therapy (NRT) versus placebo in smokers with current depression and found a positive, although not significant, effect (N = 196, RR 2.64, 95% CI 0.93 to 7.45). Meta-analysis also found a positive, although not significant, effect for NRT versus placebo in smokers with past depression (3 trials, N = 432, RR 1.17, 95% CI 0.85 to 1.60). Three trials compared other pharmacotherapy versus placebo and six trials compared other interventions in smokers with current or past depression. Due to heterogeneity between the interventions of the included trials we did not estimate pooled effects. AUTHORS' CONCLUSIONS Evidence suggests that adding a psychosocial mood management component to a standard smoking cessation intervention increases long-term cessation rates in smokers with both current and past depression when compared with the standard intervention alone. Pooled results from four trials suggest that use of bupropion may increase long-term cessation in smokers with past depression. There was no evidence found for the use of bupropion in smokers with current depression. There was not enough evidence to evaluate the effectiveness of the other antidepressants in smokers with current or past depression. There was also not enough evidence to evaluate the group of trials that investigated interventions without specific mood management components for depression, including NRT and psychosocial interventions.
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