Understanding how a smoking cessation intervention changes beliefs, self-efficacy, and intention to quit: a secondary analysis of a pragmatic randomized controlled trial

Effectiveness of health education and counseling on stages of change, decisional balance, and smoking cessation self-efficacy: A prospective self-control study

OBJECTIVE

To examine the effectiveness of health education and counseling on the stages of change, decisional balance, and smoking cessations elf-efficacy in smokers with no intention of quitting.

METHODS

A prospective self-controlled design was conducted between December 2020 and December 2022. The research period was divided into a control stage (first to fourth weeks) and an experimental stage (fifth to eighth weeks). Patients with coronary artery disease (CAD) and habitually smoked were recruited. Pearson correlation and a one-factor repeated-measurement analysis were performed to assess the effectiveness of the intervention.

RESULTS

In total, 108 male CAD patients with a mean age of 58.1 years were recruited. After 4 weeks of the intervention, 55 (51%) exhibited behavior change (X 2 = 18.03, p = .001). The decisional balance and smoking cessation self-efficacy scores significantly improved in the experimental stage. No significant differences were observed in the control stage.

CONCLUSIONS

Four weeks of health education and counseling could effectively improve participants' stage of change, decisional balance, and smoking cessation self-efficacy.

PRACTICE IMPLICATION

Healthcare professionals can play key roles in helping CAD patients successfully quit smoking through individual education and counseling.

Translating pediatric primary care best practice guidelines for addressing tobacco in the WIC system

Tobacco smoke exposure (TSE) adversely affects child health. Intervention research on reducing childhood TSE and uptake of evidence-based smoking cessation programs has had limited reach in high-risk communities. Intervening in clinics delivering the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could address overlapping public health priorities essential for healthy child development-nutrition and smoke-free environments. The Babies Living Safe and Smokefree (BLiSS) trial addresses existing gaps by implementing and evaluating a WIC in-clinic evidence-based training based on Ask, Advise, and Refer (AAR) guidelines. WIC nutrition staff (n = 67) completed surveys pre- and post-training as part of the larger BLiSS trial. Staff sociodemographic data, knowledge, and attitudes about maternal smoking and child TSE prevention, and AAR practices in clinic were collected using self-administered surveys. Pre-post outcomes were assessed using bivariate statistics and multiple regression models. Controlling for baseline AAR-related practices and other covariates, nutrition managers were more likely to engage in post-training AAR practices than nutrition assistants. Sociodemographics and smoking status were not related to post-training AAR. Lower perceived barriers and higher reported frequency of tobacco intervention practices at baseline were associated with higher engagement in post-test AAR practices. WIC-system interventions aimed at reducing child TSE and maternal tobacco smoking may be more effective if nutrition management-level staff are involved in assessment and by addressing barriers related to TSE among nutrition assistants. Findings suggest that WIC in-clinic training may help to increase self-efficacy for staff engagement in brief screening, intervention, and referral practices.

Relationships among Self-Efficacy, Quality of Life, Perceived Vulnerability, and Readiness to Quit Smoking in People Living with HIV

Smoking-related diseases (e.g., lung cancer) are the leading cause of mortality in HIV-infected patients. While many PLWH who smoke report a desire to quit, a majority of them have low readiness to quit. This study used logistic and linear regression to examine the relations among two (continuous vs. binary) measures of readiness to quit, smoking cessation self-efficacy (SE), quality of life (QoL), and perceived vulnerability (PV) using baseline data from 100 PLWH who smoke who participated in a clinical trial. Results showed no significant main effects (SE, QoL, and PV) or interaction effects (SE × QoL and SE × PV) on a continuous measure of readiness to quit. However, a follow-up analysis revealed that SE had a curvilinear effect on readiness to quit such that self-efficacy was positively associated with readiness to quit except at the highest levels of self-efficacy where readiness to quit declined. Greater SE significantly increased the likelihood of reporting readiness to quit (yes/no) among those with low QoL or high PV. For PLWH who smoke, improving self-efficacy may increase readiness to quit especially among those with lower quality of life. Psychoeducation tailored to PLWH designed to reduce unrealistic invulnerability to smoking-related diseases along with interventions that target self-efficacy may improve readiness to quit.

Association Between Anxiety Symptoms and Problematic Smartphone Use Among Chinese University Students: The Mediating/Moderating Role of Self-Efficacy

Problematic smartphone use (PSU) is a novel manifestation of addictive behaviors. It is frequently reported to be correlated with anxiety symptoms among University students. However, the underlying mechanism has not yet been thoroughly studied. Whether the association between anxiety symptoms and PSU is mediated or moderated by self-efficacy remains unclarified. A cluster sampling cross-sectional study was thus conducted to explore the potential mediating or moderating effect of self-efficacy in Chinese University students. Participants (N = 1,113) were recruited from eight Universities in Shenyang, China. Of them, 146 did not effectively respond to the questionnaires. Thus, 967 participants were eligible for the final analysis. The mediating or moderating role of self-efficacy in the anxiety-PSU relationship was explored using hierarchical multiple regression. Then the mediation model was further verified using the SPSS macros program (PROCESS v3.0). Our results showed that anxiety symptoms was positively correlated with PSU (r = 0.302, P < 0.01), while self-efficacy was negatively correlated with anxiety symptoms and PSU (r = -0.271 and -0.181, P < 0.01). Self-efficacy partly mediated the relationship between anxiety symptoms and PSU, which accounted for ~17.5% of the total effect that anxiety symptoms have on PSU. However, the moderating effect of self-efficacy on the anxiety-PSU relationship was insignificant. In summary, our findings suggested that self-efficacy partly mediates but not moderates the link between anxiety symptoms and PSU among Chinese University students. Therefore, multicomponent interventions should be made to restrict the frequency of smartphone usage, enhance the level of self-efficacy, and thus promote the mental health status of University students.

Patients' self-reported receipt of brief smoking cessation interventions based on a decision support tool embedded in the healthcare information system of a large general hospital in China

INTRODUCTION

Healthcare information systems (HIS) are used to aid healthcare providers delivering brief smoking cessation interventions. However, evidence regarding the effectiveness of intervention models in developing countries remains limited. A smoking cessation intervention model based on a decision support tool embedded in HIS (an 'e-information model', including Ask, Advise, Assess, Inform, Refer and Print components) was applied in a large urban general hospital in Beijing, China. The current study was a preliminary evaluation of the implementation and effectiveness of this model.

METHODS

We conducted a retrospective investigation in the outpatient department of the hospital in the period June-July 2017. Using a paper questionnaire, patients' self-reported receipt of the e-information model in the past 2 months and their plans to quit within 1 month were collected. Multivariate logistic regression analysis was used to examine the association between receiving the e-information model and patients' plans to quit.

RESULTS

Among 656 currently smoking patients, the proportion of patients receiving the Ask, Advise, Assess, Refer and Print components were 73.2%, 65.4%, 49.8%, 16.0% and 10.4%, respectively. The results revealed a dose-response relationship between the number of components received and the proportion of patients planning to quit (p-trend=0.006). The likelihood of patients planning to quit within 1 month was highest among those receiving all five components (OR=2.79, 95% CI: 1.31-5.94). Moreover, a simplified model composed of two or three components also revealed a potential effect on increasing the proportion of patients planning to quit.

CONCLUSIONS

The e-information model was applied effectively in the study hospital and appeared to encourage patients to plan to quit smoking. This model could be generalized to other hospitals in China and other developing countries. However, many components of this model were less utilized, and comprehensive measures will be required to improve its application in the future.

Predictors of Smoking Cessation Among College Students in a Pragmatic Randomized Controlled Trial

An effective strategy to quit smoking should consider demographic aspects, smoking-related characteristics and psychological factors. This study examined potential predictors of smoking cessation in Spanish college students. A total of 255 college student smokers (18-24 years old), recruited to a cessation trial (Spain, 2013-2014), comprised an observational cohort. The main outcome was biochemically verified (urine cotinine) abstinence at the 6-month follow-up. Baseline potential predictors included socio-demographic, smoking-related and psychological variables (Fagerström Test for Nicotine Dependence (FTND), expired monoxide level (CO), intention to quit, previous quit attempts, participation in previous multicomponent programmes and confidence in quitting). Logistic regression models were used to identify potential predictors, the area under the ROC curve (AUC) was used to discriminate the capacity of the predictors and the Hosmer-Lemeshow goodness-of-fit test was used to assess model calibration. After 6 months of follow-up, variables related to high nicotine dependence, FTND and expired CO levels were associated with lower odds of quitting smoking (OR = 0.69 [95% CI 0.54-0.89] and 0.84 [0.77-0.92], respectively). Furthermore, being prepared to change (OR = 3.98 [1.49-10.64], p = 0.006) and being confident to quit (OR = 4.73 [2.12-10.55], p < 0.001) were also potential predictors of smoking cessation. The model that combined all these variables had the best predictive validity (AUC = 0.84 [0.78-0.91], p = 0.693) and showed good predictive capacity (χ² = 10.36, p = 0.241). Findings highlight that, in this population of college student smokers, having a lower level of nicotine dependence, being prepared to quit and having the confidence in the ability to quit were associated with smoking cessation, and these factors had good predictive capacity.