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He WJA, Wang Q, Chan CHH, Luk TT, Wang MP, Chan SCS, Lam TH, Cheung YTD. Effectiveness of mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling at outdoor smoking hotspots: A cluster randomized controlled trial. Addiction 2024. [PMID: 39256314 DOI: 10.1111/add.16666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 08/07/2024] [Indexed: 09/12/2024]
Abstract
AIMS To evaluate the effectiveness of mobile smoking cessation (SC) treatment with 1-week nicotine replacement therapy (NRT) sampling on recruitment and quitting outcomes. DESIGN Two-arm cluster RCT (1:1 ratio), single-blinded, at 244 recruitment sessions in Hong Kong outdoor smoking hotspots from October 2018-December 2019. SETTING Participant were recruited by ambassadors and treated at the mobile SC truck. PARTICIPANTS 834 adult (≥18 years, male 81.3%) daily smokers, Chinese-speaking, non-NRT users in the past month, consented after nurse-led intervention in mobile SC truck were randomized to the experimental (n = 482 male 79.5%) and the control group (n = 352, male 83.8%). INTERVENTION AND COMPARATOR The experimental group received a 1-week free NRT sample, an NRT instruction card, and mobile SC treatment including onsite nurse-led brief medication advice (about 15 minutes) and referral to SC clinics. The control group received the same mobile SC treatment. MEASUREMENTS Primary outcome was self-reported quit attempts at 1-month follow-up. Secondary outcomes included SC service use at 1 month, and biochemically validated abstinence (exhaled carbon monoxide < 4 ppm; or saliva cotinine < 10 ng/ml) at 6-month follow-up. Additionally, a post-hoc cost analysis was conducted. FINDINGS By intention-to-treat, the two groups showed similar prevalence of quit attempts (44·4% versus 43·5%, risk ratio (RR) = 1·04, 95% confidence interval (CI) = 0·79-1·37, P = 0·79). Compared with the control group, the experimental group showed lower SC service use at clinics (32·4% versus 44·9%, RR = 0·72, 95%CI = 0·57-0·91, P = 0·006), but no significant difference in validated abstinence (4·6% versus 2·8%, RR = 1·64, 95%CI = 0·76-3·50, P = 0·21). The experimental recruitment sessions recruited more smokers for onsite medication advice than the control session (mean 6·7 vs 5·0, adjusted incident rate ratio = 1·30, 95%CI = 1·08-1·56, P = 0·005). CONCLUSIONS Mobile smoking cessation treatment with 1-week nicotine replacement therapy sampling did not increase quit attempts or abstinence outcomes among recruited daily smokers in Hong Kong. The intervention increased smokers' uptake of onsite medication advice but reduced subsequent smoking cessation service use at clinics.
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Affiliation(s)
- Wan Jia Aaron He
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Qi Wang
- School of Graduate Studies, Lingnan University, Hong Kong
| | | | - Tzu Tsun Luk
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Siu Chee Sophia Chan
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yee Tak Derek Cheung
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
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Wu YS, Cheung YTD, Lee JJJ, Wong CKH, Ho SY, Li WHC, Yao Y, Lam TH, Wang MP. Effect of Adding Personalized Instant Messaging Apps to a Brief Smoking Cessation Model in Community Smokers in Hong Kong: Pragmatic Randomized Clinical Trial. J Med Internet Res 2024; 26:e44973. [PMID: 38739429 PMCID: PMC11130779 DOI: 10.2196/44973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 09/28/2023] [Accepted: 03/26/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND While text messaging has proven effective for smoking cessation (SC), engagement in the intervention remains suboptimal. OBJECTIVE This study aims to evaluate whether using more interactive and adaptive instant messaging (IM) apps on smartphones, which enable personalization and chatting with SC advisors, can enhance SC outcomes beyond the provision of brief SC advice and active referral (AR) to SC services. METHODS From December 2018 to November 2019, we proactively recruited 700 adult Chinese daily cigarette users in Hong Kong. Participants were randomized in a 1:1 ratio. At baseline, all participants received face-to-face brief advice on SC. Additionally, they were introduced to local SC services and assisted in selecting one. The intervention group received an additional 26 personalized regular messages and access to interactive chatting through IM apps for 3 months. The regular messages aimed to enhance self-efficacy, social support, and behavioral capacity for quitting, as well as to clarify outcome expectations related to cessation. We developed 3 sets of messages tailored to the planned quit date (within 30 days, 60 days, and undecided). Participants in the intervention group could initiate chatting with SC advisors on IM themselves or through prompts from regular messages or proactive inquiries from SC advisors. The control group received 26 SMS text messages focusing on general health. The primary outcomes were smoking abstinence validated by carbon monoxide levels of <4 parts per million at 6 and 12 months after the start of the intervention. RESULTS Of the participants, 505/700 (72.1%) were male, and 450/648 (69.4%) were aged 40 or above. Planning to quit within 30 days was reported by 500/648 (77.2%) participants, with fewer intervention group members (124/332, 37.3%) reporting previous quit attempts compared with the control group (152/335, 45.4%; P=.04). At the 6- and 12-month follow-ups (with retention rates of 456/700, 65.1%, and 446/700, 63.7%, respectively), validated abstinence rates were comparable between the intervention (14/350, 4.0%, and 19/350, 5.4%) and control (11/350, 3.1% and 21/350, 6.0%) groups. Compared with the control group, the intervention group reported greater utilization of SC services at 12 months (RR 1.26, 95% CI 1.01-1.56). Within the intervention group, engaging in chat sessions with SC advisors predicted better validated abstinence at 6 months (RR 3.29, 95% CI 1.13-9.63) and any use of SC services (RR 1.66, 95% CI 1.14-2.43 at 6 months; RR 1.67, 95% CI 1.26-2.23 at 12 months). CONCLUSIONS An IM-based intervention, providing support and assistance alongside brief SC advice and AR, did not yield further increases in quitting rates but did encourage the utilization of SC services. Future research could explore whether enhanced SC service utilization leads to improved long-term SC outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03800719; https://clinicaltrials.gov/ct2/show/NCT03800719.
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Affiliation(s)
- Yongda Socrates Wu
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | | | - Jay Jung Jae Lee
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - William Ho Cheung Li
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Ying Yao
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Bhatt G, Goel S, Kiran T, Grover S, Medhi B, Singh G, Singh Gill S. Estimating the Cost of Delivering Tobacco Cessation Intervention Package at Noncommunicable Disease Clinics in Two Districts of North India. Nicotine Tob Res 2023; 25:1727-1735. [PMID: 37402314 PMCID: PMC10475607 DOI: 10.1093/ntr/ntad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/08/2023] [Accepted: 07/03/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION Integrated care is likely to improve outcomes in strained healthcare systems while limiting costs. NCD clinics were introduced under the "National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke" (NPCDCS) in India; however, there is limited literature on the costs of delivering tobacco cessation interventions within NPCDCS. One of the study's objectives was to estimate the cost of delivering a culturally specific patient-centric behavioral intervention package in two district-level NCD clinics in Punjab, India. METHODS Costing was undertaken using the health systems perspective. A top-down or financial costing approach and a bottom-up or activity-based approach were employed at each step of development and implementation. The opportunity cost was used to include the cost of human resources, infrastructure, and capital resources used. All infrastructure and capital costs were annualized using a 3% annual discount rate. Four additional scenarios were built up concerning three major components to reduce costs further when rolled out on a large scale. RESULTS The cost of intervention package development, human resource training, and unit cost of implementation were estimated to be INR 6,47,827 (USD 8,874); INR 134,002 (USD 1810); and INR 272 (USD 3.67), respectively. Based on our sensitivity analysis results, the service delivery cost varied from INR 184 (USD 2.48) to INR 326 (USD 4.40) per patient. CONCLUSION The development costs of the intervention package accounted for the majority proportion of the total cost. Of the total unit cost of implementation, the telephonic follow-up, human resources, and capital resources were the major contributory components. IMPLICATIONS The current study aims to fill gaps by estimating the unit-level health systems cost of a culturally sensitive, disease-specific, and patient-centric tobacco cessation intervention package delivered at the outpatient settings of NCD clinics at the secondary level hospital, which represents a major link in the health care system of India. Findings from this study could be used to provide supportive evidence to policymakers and program managers for rolling out such interventions in established NCD clinics through the NPCDCS program of the Indian Government.
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Affiliation(s)
- Garima Bhatt
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-160012, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-160012, India
- Faculty of Education & Health Sciences, University of Limerick, Ireland
- Honorary Professor in the Faculty of Human & Health Sciences at Swansea University, United Kingdom
| | - Tanvi Kiran
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh-160012, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bikash Medhi
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gurmandeep Singh
- National Health Mission, Department of Health & Family Welfare Government of Punjab, Chandigarh, India
| | - Sandeep Singh Gill
- National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS), Department of Health & Family Welfare, Government of Punjab, Chandigarh, India
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Zhang MJ, He WJA, Luk TT, Wang MP, Chan SSC, Cheung YTD. Effectiveness of personalized smoking cessation intervention based on ecological momentary assessment for smokers who prefer unaided quitting: protocol for a randomized controlled trial. Front Public Health 2023; 11:1147096. [PMID: 37583881 PMCID: PMC10425238 DOI: 10.3389/fpubh.2023.1147096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Ecological momentary assessment (EMA)-based smoking cessation intervention may help personalize intervention for smokers who prefer to quit smoking unaided. This study aims to evaluate the effectiveness of EMA-based phone counseling and instant messaging for smoking cessation. Methods/design This is a two-arm, accessor-blinded, simple individual randomized controlled trial (allocation ratio 1:1). Participants will be recruited from community sites and online platforms in Hong Kong. Interventions will be delivered via a phone call and instant messaging. Current adult smokers who (1) self-report no intention to use smoking cessation services and medication in the coming month and (2) have not used smoking cessation services or nicotine replacement therapy in the past 7 days will be recruited. Recruited participants will be randomized to intervention or control groups via an online randomizer. All participants will be required to complete EMAs (five times per day for 7 consecutive days). The intervention group (n = 220) will receive a nurse-led brief phone counseling immediately after the 1-week EMAs and 10-week EMA-based advice via instant messaging applications (e.g., WhatsApp, WeChat). The 10-week EMA-based advice covers a summary of the 1-week EMAs, and tailored cessation support focused on personalized smoking triggers. The control group (n = 220) will not receive any intervention during the same period. The primary outcomes are participants' progression toward smoking cessation assessed by the Incremental Behavior Change toward Smoking Cessation (IBC-S) and biochemically validated abstinence at the 3-month follow-up. Secondary outcomes include self-reported and biochemically validated tobacco abstinence at the 6-month follow-up. Discussion The findings will provide evidence that the EMA-based tailored smoking cessation intervention can be adapted as a new health promotion strategy for current smokers who are unwilling to use smoking cessation aids. Clinical trial registration https://classic.clinicaltrials.gov/ct2/show/NCT05212220, identifier: NCT05212220.
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Affiliation(s)
| | | | | | | | | | - Yee Tak Derek Cheung
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Sun Y, Wu YS, Cheung YTD, Wang MP, Chen J, Leung LT, Zhang X, Chak KY, Lam TH, Ho SY. Impact of mandatory masking amid the COVID-19 pandemic on outdoor smoking: an interrupted time-series analysis of a 33-month unobtrusive observational study. Front Public Health 2023; 11:1136621. [PMID: 37521998 PMCID: PMC10372439 DOI: 10.3389/fpubh.2023.1136621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023] Open
Abstract
Background Mask-wearing in outdoor public places in Hong Kong was mandated on 29 July 2020, amid the COVID-19 pandemic. We aimed to evaluate the impact of mandatory masking with no exemption for smoking on outdoor smoking. Methods We conducted 253 unobtrusive observations at 10 outdoor smoking hotspots in 33 months from July 2019 to March 2022 and counted smokers and non-smoking pedestrians in fixed boundaries. We conducted interrupted time-series analyses on the monthly mean volume of smokers (persons per hour) using generalized linear models. The independent variables were as follows: time since the first observation, implementation of the mask regulation, time since the regulation, seasonality, and waves 1-5 outbreaks. We checked the robustness of the association using the daily mean volume of smokers as the dependent variable. Two sensitivity analyses were conducted to include the hotspot location or the number of all pedestrians as an offset. Results Monthly outdoor smoking decreased immediately after the regulation (incidence rate ratio [IRR]: 0.505, 95% confidence interval [CI]: 0.374 to 0.680, P < 0.001). Daily smoking analysis and the two sensitivity analyses supported the results. However, monthly outdoor smoking increased by 11% since the regulation (IRR: 1.110, 95% CI: 1.074 to 1.147, P < 0.001). An exception was observed at the most severe wave 5 outbreak when monthly outdoor smoking decreased (IRR: 0.415, 95% CI: 0.327 to 0.525, P < 0.001). Conclusion Outdoor smoking fell immediately after mandatory masking, rebounded to pre-pandemic levels, and decreased again at the most severe wave 5.
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Affiliation(s)
- Yuying Sun
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, Hong Kong SAR, China
| | - Yongda Socrates Wu
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | | | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jianjiu Chen
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xiaoyu Zhang
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kin Yeung Chak
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Zhao SZ, Weng X, Luk TT, Wu Y, Cheung DYT, Li WHC, Tong H, Lai V, Lam TH, Wang MP. Adaptive interventions to optimise the mobile phone-based smoking cessation support: study protocol for a sequential, multiple assignment, randomised trial (SMART). Trials 2022; 23:681. [PMID: 35982468 PMCID: PMC9387009 DOI: 10.1186/s13063-022-06502-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) is promising in developing personalised smoking cessation interventions. By using an adaptive trial design, we aim to evaluate the effectiveness of personalised mHealth intervention in increasing smoking cessation. METHODS This study is a two-arm, parallel, accessor-blinded Sequential Multiple-Assignment Randomised Trial (SMART) that randomises 1200 daily cigarette smokers from 70 community sites at two timepoints. In the first phase, participants receive brief cessation advice plus referral assistance to smoking cessation services and are randomly allocated to receive personalised instant messaging (PIM) or regular instant messaging (RIM). In the second phase, PIM participants who are non-responders (i.e. still smoking at 1 month) are randomised to receive either optional combined interventions (multi-media messages, nicotine replacement therapy sampling, financial incentive for active referral, phone counselling, and family/peer support group chat) or continued-PIM. Non-responders in the RIM group are randomised to receive PIM or continued-RIM. Participants who self-report quitting smoking for 7 days or longer at 1 month (responders) in both groups continue to receive the intervention assigned in phase 1. The primary outcomes are biochemical abstinence validated by exhaled carbon monoxide (< 4 ppm) and salivary cotinine (< 10 ng/ml) at 3 and 6 months from treatment initiation. Intention-to-treat analysis will be adopted. DISCUSSION This is the first study using a SMART design to evaluate the effect of adaptive mHealth intervention on abstinence in community-recruited daily smokers. If found effective, the proposed intervention will inform the development of adaptive smoking cessation treatment and benefits smokers non-responding to low-intensity mHealth support. TRIAL REGISTRATION ClinicalTrials.gov NCT03992742 . Registered on 20 June 2019.
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Affiliation(s)
- Sheng Zhi Zhao
- School of Nursing, The University of Hong Kong, Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Xue Weng
- School of Nursing, The University of Hong Kong, Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong. .,Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China.
| | - Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Yongda Wu
- School of Nursing, The University of Hong Kong, Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Derek Yee Tak Cheung
- School of Nursing, The University of Hong Kong, Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - William Ho Cheung Li
- The Nethersole School of Nursing, Chinese University of Hong Kong, Ma Liu Shui, Hong Kong
| | - Henry Tong
- Hong Kong Council on Smoking and Health, Wan Chai, Hong Kong
| | - Vienna Lai
- Hong Kong Council on Smoking and Health, Wan Chai, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.
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Chalela P, McAlister AL, Despres C, Muñoz E, Sukumaran P, Akopian D, Kaghyan S, Trujillo J, Ramirez AG. Direct Outreach in Bars and Clubs to Enroll Cigarette Smokers in Mobile Cessation Services: Exploratory Study. JMIR Form Res 2022; 6:e28059. [PMID: 35653173 PMCID: PMC9204570 DOI: 10.2196/28059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/30/2021] [Accepted: 01/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Cigarette smoking and alcohol use are well known to be concomitant behaviors, but there is a lack of studies related to recruitment of smokers for mobile cessation services at places where alcohol is consumed, such as bars and clubs. Adapting recruitment strategies to expand the reach of cessation programs to where tobacco users are located may help decrease the health-equity gap in tobacco control by improving reach and enrollment of underserved smokers residing in low-income and rural areas who are not reached by traditional cessation services. Objective The purpose of this exploratory study was to assess the feasibility of direct outreach in bars, clubs, and restaurants to recruit smokers to Quitxt, our mobile smoking cessation service. Quitxt is delivered through SMS text messaging or Facebook Messenger. Methods We collaborated with an advertising agency to conduct in-person recruitment of young adult smokers aged 18-29 years, focusing on urban and rural Spanish-speaking Latino participants, as well as English-speaking rural White and African American participants. Street team members were recruited and trained in a 4-hour session, including a brief introduction to the public health impacts of cigarette smoking and the aims of the project. The street teams made direct, face-to-face contact with smokers in and near smoking areas at 25 bars, clubs, and other venues frequented by young smokers in urban San Antonio and nearby rural areas. Results The 3923 interactions by the street teams produced 335 (8.5%) program enrollments. Most participants were English speakers with a mean age of 29.2 (SD 10.6) years and smoked a mean of 8.5 (SD 6.2) cigarettes per day. Among users who responded to questions on gender and ethnicity, 66% (70/106) were women and 56% (60/107) were Hispanic/Latino. Among users ready to make a quit attempt, 22% (17/77) reported 1 tobacco-free day and 16% (10/62) reported maintaining cessation to achieve 1 week without smoking. The response rate to later follow-up questions was low. Conclusions Direct outreach in bars and clubs is a useful method for connecting young adult cigarette smokers with mobile cessation services. However, further research is needed to learn more about how mobile services can influence long-term smoking cessation among those recruited through direct outreach, as well as to test the use of incentives in obtaining more useful response rates.
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Affiliation(s)
- Patricia Chalela
- Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Alfred L McAlister
- School of Public Health, Austin Regional Campus, University of Texas Health Science Center at Houston, Austin, TX, United States
| | - Cliff Despres
- Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Edgar Muñoz
- Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Pramod Sukumaran
- Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - David Akopian
- College of Engineering, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Sahak Kaghyan
- College of Engineering, The University of Texas at San Antonio, San Antonio, TX, United States
| | | | - Amelie G Ramirez
- Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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Cheung YTD, Jiang N, Jiang CQ, Zhuang RS, Gao WH, Zhou J, Lu JH, Li H, Wang JF, Lai YS, Sun JS, Wu JC, Ye C, Li N, Zhou G, Chen JY, Ou XY, Liu LQ, Huang ZH, Ho SY, Li HCW, Su SH, Yang Y, Jiang Y, Zhu WH, Yang L, Lin P, He Y, Cheng KK, Lam TH. Physicians' very brief (30-sec) intervention for smoking cessation on 13 671 smokers in China: a pragmatic randomized controlled trial. Addiction 2021; 116:1172-1185. [PMID: 32918512 PMCID: PMC8246886 DOI: 10.1111/add.15262] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/11/2020] [Accepted: 09/02/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Three to 10 minutes of smoking cessation advice by physicians is effective to increase quit rates, but is not routinely practised. We examined the effectiveness of physicians' very brief (approximately 30 sec) smoking cessation intervention on quit rates among Chinese outpatient smokers. DESIGN A pragmatic, open-label, individually randomized controlled trial. SETTING Seventy-two medical outpatient departments of hospitals and/or community health centers in Guangdong, China. PARTICIPANTS Chinese adults who were daily cigarette smokers (n = 13 671, 99% males) were invited by their physician to participate during outpatient consultation. Smokers who were receiving smoking cessation treatment or were judged to need specialist treatment for cessation were excluded. INTERVENTIONS The intervention group (n = 7015) received a 30-sec intervention including physician's very brief advice, a leaflet with graphic warnings and a card with contact information of available cessation services. The control group (n = 6656) received a very brief intervention on consuming vegetables and fruit. A total of 3466 participants in the intervention group were further randomized to receive a brief booster advice from trained study personnel via telephone 1 month following their doctor visit. MEASUREMENTS The primary outcome was self-reported 7-day point prevalence abstinence (PPA) in the intervention and control groups at the 12-month follow-up. Secondary outcomes included self-reported 30-day abstinence and biochemically validated abstinence at 12-month follow-up. FINDINGS By intention-to-treat, the intervention (versus control) group had greater self-reported 7-day abstinence [9.1 versus 7.8%, odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.03-1.26, P = 0.008] and 30-day abstinence (8.0 versus 6.9%, OR = 1.14, 95% CI = 1.03-1.27, P = 0.01) at 12-month follow-up. The effect size increased when only participants who received the intervention from compliant physicians were included (7-day PPA, OR = 1.42, 95% CI = 1.11-1.74). The group difference in biochemically validated abstinence was small (0.8 versus 0.8%, OR = 1.00, 95% CI = 0.71-1.42, P = 0.99). CONCLUSION A 30-sec smoking cessation intervention increased self-reported abstinence among mainly male smokers in China at 12-month follow-up (risk difference = 1.3%), and should be feasible to provide in most settings and delivered by all health-care professionals.
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Affiliation(s)
| | - Nan Jiang
- Department of Population Health, Grossman School of MedicineNew York UniversityNew YorkNYUSA
| | | | - Run Sen Zhuang
- Shenzhen Health Education and Promotion CentreShenzhenChina
| | - Wen Hui Gao
- Shenzhen Health Education and Promotion CentreShenzhenChina
| | - Jian Zhou
- Department of Respiratory MedicineGuangzhou Medical University Second Affiliated HospitalGuangzhouChina
| | - Jin Hong Lu
- Traditional Chinese Medical Hospital of HuangpuGuangzhouChina
| | - Hui Li
- Shenzhen Bao'an District Songgang People's Hospital, Hongqiaotou Community Health Service CenterShenzhenChina
| | - Jun Feng Wang
- The Fifth Affiliated Hospital of Sun Yat‐sen University, ZhongshangChina
| | - Yi Sheng Lai
- Shenzhen Longgang District Central HospitalShenzhenChina
| | - Jun Sheng Sun
- Shenzhen Longgang District Central HospitalShenzhenChina
| | - Jiu Chang Wu
- Shenzhen Bao'an District Fuyong HospitalShenzhenChina
| | - Chiang Ye
- Division of EndocrinologyShenzhen Bao'an District People's HospitalShenzhenChina
| | - Na Li
- Shenzhen Longgang District Central HospitalShenzhenChina
| | - Gang Zhou
- Guangzhou No. 12 HospitalGuangzhou Guangdong ProvinceChina
| | - Jing Ying Chen
- Shenzhen Longgang District Second People's HospitalShenzhenChina
| | - Xiu Yan Ou
- ZhongShan City People's Hospital, ZhongShanChina
| | - Liu Qing Liu
- Longhua District People's Hospital Yansong Community CenterShenzhenChina
| | - Zhuang Hong Huang
- The First Affiliated Hospital of Shantou University Medical College Guan Bu Zhai Mei Healthcare StationShantouChina
| | - Sai Yin Ho
- School of Public HealthThe University of Hong KongHong Kong, China
| | | | - Sheng Hua Su
- Health Care Center for Cadre of Guangdong ProvinceGuangzhouChina
| | - Yan Yang
- Tobacco Control Office, Chinese Center for Disease Control and PreventionChina
| | - Yuan Jiang
- Tobacco Control Office, Chinese Center for Disease Control and PreventionChina
| | - Wei Hua Zhu
- Guangzhou No. 12 HospitalGuangzhou Guangdong ProvinceChina
| | - Lie Yang
- Guangzhou No. 12 HospitalGuangzhou Guangdong ProvinceChina
| | - Peiru Lin
- Guangzhou First Municipal People's Hospital, Guangzhou Medical UniversityGuangzhouChina
| | - Yao He
- Institute of Geriatrics, Chinese PLA General HospitalBeijingChina
| | - Kar Keung Cheng
- Institute of Applied Health ResearchUniversity of BirminghamUK
| | - Tai Hing Lam
- School of Public HealthThe University of Hong KongHong Kong, China
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9
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First Report on Smoking and Infection Control Behaviours at Outdoor Hotspots during the COVID-19 Pandemic: An Unobtrusive Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031031. [PMID: 33503837 PMCID: PMC7908604 DOI: 10.3390/ijerph18031031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/24/2022]
Abstract
This study was to observe smoking behaviours and infection control behaviours in smokers at outdoor smoking hotspots during the COVID-19 pandemic in Hong Kong. We conducted unobtrusive observations at nine hotspots during 1 July 2019-31 January 2020 (pre-outbreak, 39 observations), 1 February-30 April 2020 (outbreak, eight observations), and 1 May-11 June 2020 (since-outbreak, 20 observations). Sex, age group, type of tobacco products used, duration of stay, group smoking behaviours, face mask wearing and infection control behaviours of smokers, and mask wearing of non-smoking pedestrians were observed. Compared with pre-outbreak, lower volumes of smokers were observed during outbreak and since-outbreak. Smokers gathered more in a group (24.5% and 25.8% vs. 13.4%, respectively) and stayed longer (91.5% and 83.6% vs. 80.6% stayed ≥1 min) during outbreak and since-outbreak than pre-outbreak. Ninety-six percent smokers possessed a face mask. While smoking, 81.6% of smokers put the mask under the chin and 13.8% carried it in the hand, 32.4% did not wear a mask immediately after smoking, 98.0% did not sanitize hands, and 74.3% did not keep a distance of at least one metre. During the COVID-19 pandemic, smokers gathered closely and stayed longer at the hotspots, and few practised hand hygiene, all of which may increase the risk of infection.
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10
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Cheung YTD, Chan CHH, Ho KS, Tang C, Lau CWH, Li WHC, Wang MP, Lam TH. Effectiveness of nicotine replacement therapy sample at outdoor smoking hotspots for initiating quit attempts and use of smoking cessation services: a protocol for a cluster randomised controlled trial. BMJ Open 2020; 10:e036339. [PMID: 32269028 PMCID: PMC7170641 DOI: 10.1136/bmjopen-2019-036339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION More than half of the smoking population in Hong Kong are unmotivated to quit. Only about 2% of tobacco users in the territory have ever used cessation aids such as nicotine replacement therapy (NRT). The present study aims to assess the effectiveness of delivering 1-week free NRT sample plus brief intervention to smokers at outdoor smoking hotspots on quit attempts and use of smoking cessation services. METHODS AND ANALYSIS This is a two-arm, pragmatic, multisite, cluster randomised controlled trial (RCT) on the effectiveness of increasing quit attempts, use of cessation service and recruitment outcomes. Trained smoking cessation ambassadors will approach smokers at outdoor smoking hotspots, and deliver brief smoking cessation advice. Recruitment sessions are randomised to intervention or control group (allocation ratio 1:1). Participants in the intervention group (n=550) will receive 1-week free NRT sample (either patch or gum), brief medication advice from an onsite nurse and cessation service referral, whereas participants in control group (n=275) will only receive the brief advice and service referral. The primary outcomes are the proportion of participants who enrol in any cessation service in Hong Kong within 1 month of the recruitment, and the proportion of participants who report quit attempts at 1-month follow-up. Secondary outcomes include self-reported use of NRT, self-reported 7-day tobacco abstinence, 30-day abstinence at 3 months and 6 months, biochemically validated abstinence at 6 months, perceived importance, difficulty and confidence to quit (scale 0-10), and Incremental Behavior Change towards Smoking Cessation. Process outcomes include number of smokers who will be approached, will accept the brief smoking cessation advice or be recruited to participate in the RCT. ETHICS AND DISSEMINATION The Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster approved the trial (UW 18-118). Findings will be disseminated through funding website, publication and conference presentations. TRIAL REGISTRATION NUMBER NCT03717051.
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Affiliation(s)
| | - Ching Han Helen Chan
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong, Hong Kong
| | - Kin Sang Ho
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong, Hong Kong
| | - Celeste Tang
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong, Hong Kong
| | | | | | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
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11
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Cheung YTD, Cheung Li WH, Wang MP, Lam TH. Delivery of a Nicotine Replacement Therapy Sample at Outdoor Smoking Hotspots for Promoting Quit Attempts: A Pilot Randomized Controlled Trial. Nicotine Tob Res 2019; 22:1468-1475. [DOI: 10.1093/ntr/ntz138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Outdoor smoking hotspots are convenient venues for promoting smoking cessation. This randomized controlled trial aimed to obtain proof-of-concept evidence of the feasibility and preliminary effectiveness on quit attempts of delivering a 1-week free nicotine replacement therapy sample (NRTS) to smokers.
Methods
This pilot parallel, single-blinded, two-group (1:1) randomized controlled trial proactively recruited adult smokers in outdoor smoking hotspots in Hong Kong. Smokers consuming at least 10 cigarettes per day and fit for NRT use were individually randomized to receive either a 1-week NRT gum/patch and brief advice lasting 10 minutes (NRTS, n = 50), or receive only brief advice (control, n = 50). The primary outcomes were any self-reported quit attempts (stop smoking for at least 24 hours) at 1- and 3-month telephone follow-up. Risk ratios from log-binomial regression models were used to assess the associations.
Results
The NRTS increased quit attempts at 1-month (14% vs. 10%; adjusted risk ratio = 1.25, 95% CI = 0.43 to 3.61) and 3-month follow-up (26% vs. 12%; adjusted risk ratio = 2.17, 95% CI = 0.89 to 5.27), but the differences were not significant. Trial participation rate was about 81.3%. Around 54% of the intervention group participants used the NRT sample by the first month. The NRT users reported generally positive feedback about the usefulness of NRT sample for smoking cessation. Major factors of not using NRT included bad gum taste and their perception that NRT was not useful.
Conclusions
Delivering NRTS to smokers in outdoor smoking hotspots was feasible and efficacious in increasing NRT use. Additional post-recruitment support to sustain the use of NRT and cessation services is needed.
Implications
Our study supported that smokers at outdoor smoking hotspots can be approached for a brief smoking cessation intervention including an onsite delivery of NRTS. Delivering NRTS and a brief advice on using NRT to these smokers was feasible and efficacious to increase NRT use. A larger trial on the benefits on quit attempts and long-term abstinence is warranted.
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Affiliation(s)
| | | | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
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12
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Luk TT, Li WHC, Cheung DYT, Wong SW, Kwong ACS, Lai VWY, Chan SSC, Lam TH, Wang MP. Chat-based instant messaging support combined with brief smoking cessation interventions for Chinese community smokers in Hong Kong: Rationale and study protocol for a pragmatic, cluster-randomized controlled trial. Contemp Clin Trials 2019; 77:70-75. [PMID: 30593882 DOI: 10.1016/j.cct.2018.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/17/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Novel approaches to engage community smokers in smoking cessation are needed as smokers typically lack motivation to quit or use evidence-based tobacco dependence treatment. Mobile instant messaging apps (e.g., WhatsApp, Facebook Messenger) are widely used but under-studied as a mobile health modality for delivering smoking cessation support. This paper presents the rationale and study design of a trial which aims to evaluate the effectiveness of a chat-based intervention using mobile instant messaging combined with brief interventions for community smokers. METHODS This is a two-arm, parallel, accessor-blinded, pragmatic cluster-randomized controlled trial on an estimated 1172 daily cigarette smokers aged ≥18 years proactively recruited from 68 community sites (cluster) throughout Hong Kong. Subjects in intervention group received three months of chat-based, instant messaging support guided by acceptance and commitment therapy and other behavioural change techniques, integrated with brief advice and active referral to a smoking cessation service using the AWARD (Ask, Warn, Advise, Refer, Do-it-again) intervention model. Control group received brief advice to quit plus a self-help booklet at baseline. Outcomes were assessed at 1-, 2-, 3- and 6-month after baseline. The primary outcome is abstinence validated by exhaled carbon monoxide (<4 ppm) and salivary cotinine (<10 ng/mL) at 6-month after baseline. Primary analyses will be based on intention-to-treat. COMMENTS This is the first trial examining the effectiveness of a chat-based cessation support programme combined with brief interventions in promoting abstinence. The intervention model can be adapted for other behavioural change treatments and more advanced digital smoking cessation intervention.
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Affiliation(s)
- Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | | | - Sze Wing Wong
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | | | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong.
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