Gender differences in utilization of services and tobacco cessation outcomes at a state quitline

Cognitive Distortions as Barriers to Seeking Smoking Cessation Treatment: A Comparative Study

Background/Objectives: Despite the availability of effective pharmacotherapy and evidence-based treatments, a substantial proportion of smokers do not seek treatment. This study aims to explore the cognitive distortions associated with not seeking evidence-based smoking cessation treatment and to identify cognitive barriers. Methods: The research conducted in Istanbul between October and December 2017 employs a cross-sectional design and includes two groups: a treatment-seeking group comprising 156 patients diagnosed with tobacco use disorder and a non-treatment seeking group of 78 patients with tobacco use disorder who had never sought professional help for smoking cessation. A comprehensive data collection process was used, including sociodemographic information, cognitive distortion assessment using the cognitive distortions scale, a smoking-related cognitive distortions interview and the Fagerström Test for Nicotine Dependence. Results: While no significant sociodemographic differences were observed between the treatment-seeking and non-treatment-seeking groups, the study found that higher nicotine dependence was associated with a higher likelihood of seeking treatment. The treatment-seeking group displayed significantly higher levels of "all-or-nothing thinking" cognitive distortions related to smoking and smoking cessation. Conversely, the non-treatment-seeking group exhibited elevated levels of cognitive distortions such as "labeling", "mental filtering", "should statements" and "minimizing the positive" regarding receiving smoking cessation treatment. Conclusions: Understanding the cognitive distortions associated with treatment-seeking behavior for tobacco use disorder is crucial for developing targeted public-based interventions, public service announcements for tobacco use prevention and encouraging individuals to seek evidence-based treatment. Addressing these cognitive distortions can also potentially enhance the effectiveness of smoking cessation programs and reduce the global burden of tobacco-related diseases and mortality.

Acceptability of Hormonal Contraceptives as a Smoking Cessation Aid for Women of Reproductive Age: A Web-Based Cross-Sectional Survey

Introduction

Cigarette smoking is the most common cause of preventable cancers and other premature morbidity and mortality. Modifying hormonal patterns using hormonal contraceptives (HCs) may lead to improved smoking cessation outcomes in women, though the acceptability of this is unknown. Therefore, we explored the willingness of reproductive-age women who smoke to use HC for cessation.

Methods

A cross-sectional online survey was conducted with a convenience sample of reproductive-age women living in the United States who self-reported smoking combustible cigarettes. Questions covered smoking history, previous HC use, and willingness to use various HC methods (i.e., injectable, oral, patch, vaginal insert) for cessation. Chi-squared tests and logistic regression were conducted using StataBE 17.1.

Results

Of 358 eligible respondents, n = 312 (86.9%) reported previous HC use. Average age of those with HC use history was 32.1 ± 6.1 years compared with 27.8 ± 6.7 years for those without history of HC use (p = 0.001). Of respondents who reported previous HC use, 75.6% reported willingness to use HCs, compared with 60.9% of those without a history of HC use. Overall, willingness to use various types of HC ranged from 22.6% for the vaginal insert to 59.2% willing to use an oral contraceptive.

Discussion

These observations indicate that most women who smoke cigarettes are willing to use HC for a smoking cessation aid, especially if they have a history of HC use and with an oral form of HC. To improve the rate of smoking cessation for women of reproductive age, future interventions should explore how to incorporate HC for cessation.

Correlates of nicotine dependence among patients visiting a tobacco cessation centre in India: A retrospective analysis

Background We did a retrospective secondary analysis of 1-year data of a tobacco cessation clinic (TCC) to assess correlates of nicotine dependence among tobacco users visiting the TCC at a tertiary care dental hospital. Methods Secondary data were obtained from the records of patients who had visited the TCC from January to December 2019. Of the 1436 records, 1144 were found to contain all the information needed for the study. Patient records were obtained from a pre-validated standard TCC patient assessment sheet (PAS), which included various sections: Sociodemo-graphic items, tobacco use profile items, nicotine dependence status, strategy used for cessation and follow-up details. Results Of the 1144 proformas, 97.1% (n=1111) were of men and 2.9% (n=33) were of women. Around 48.5% had medium nicotine dependence followed by high nicotine dependence (29.7%) and low nicotine dependence (21.8%). The mean (SD) age of initiation of tobacco use was 26.1 (9.44) years and a significantly lower age of initiation was observed in patients with high nicotine dependence. Greater number of years of tobacco use was significantly associated with high nicotine dependence. About 47% of patients had attempted to quit tobacco in the past and the quitting attempts were found to be significantly higher in patients with high dependence. Conclusion We explored crucial determinants of nicotine dependence among tobacco users reporting to the TCC. These factors may be incorporated in routine assessment of the tobacco use status and may be used in tailored cessation counselling strategies.

Smoking cessation strategies for women: An analysis of smoking cessation determinants among Korean female smokers participating in a smoking cessation outreach program

Background: Although there is strong evidence that behavioral counseling improves quit rates, limited data are available on individualized smoking cessation counseling provided to female smokers because they often are hesitant to identify as smokers. This study aimed to elucidate factors related to smoking cessation among Korean women who participated in the smoking cessation outreach program. Methods: This retrospective descriptive study used data retrieved from the Korea Health Promotion Institute. The data included individual participant characteristics, supportive services received, and self-reported smoking cessation outcomes from June 1, 2015, to December 31, 2017. Results: Data from 709 women were analyzed. We found cessation rates of 43.3% (confidence interval [CI]=0.40, 0.47) at four weeks, 28.6% (CI=0.25, 0.32) at 12 weeks, and 21.6% (CI=0.19, 0.25) at six months. Significant determinants of quitting at six months were regular exercise (odds ratio [OR]=3.02; 95% CI=1.28, 3.29; P=0.009) and the number of counseling sessions during the first four weeks of the program (OR=1.26; 95% CI=1.04, 1.82; P=0.041). Conclusion: Providing intensive counseling during initial phase of smoking cessation program and regular exercise would be effective strategies for smoking cessation programs for women smokers to promote their health.

A Systematic Review Evaluating Disparities in State-Run Quitline Utilization and Effectiveness in the U.S

Context

Cigarette smoking is a public health problem in the U.S. and is marked by pervasive sociodemographic disparities. State-run quitlines may offer greater access to cessation services that could in turn help to reduce smoking disparities. The aim of this review was to synthesize the body of literature regarding sociodemographic disparities in the utilization and effectiveness of state-run quitlines.

Evidence acquisition

The PRISMA guidelines were followed in conducting this review. Included articles were published between January 1, 1992 and May 28, 2019 and sourced from PubMed and Web of Science. Studies that evaluated state-run quitline utilization or effectiveness (cessation) by sex, race/ethnicity, sexual or gender identity, or SES (income, education, insurance) were included.

Evidence synthesis

Our search yielded 2,091 unique articles, 17 of which met the criteria for inclusion. This review found that quitline utilization was higher among Black and Asian/Pacific Islander individuals than among White individuals and among people with lower income and lower education than among people with higher income and higher education. Quitline use was associated with less smoking cessation among females than among males, among American Indian/Alaskan Native individuals than among individuals from all other races and ethnicities, and among individuals of lower than among those of higher income and education.

Conclusions

This review found that although communities disproportionately affected by smoking utilize quitlines more commonly than their White and more affluent peers, disparities in cessation persist for American Indian/Alaskan Native and individuals from lower SES groups who use quitlines.

Sex and Gender in Lung Diseases and Sleep Disorders: A State-of-the-Art Review: Part 2

There is now ample evidence that differences in sex and gender contribute to the incidence, susceptibility, presentation, diagnosis, and clinical course of many lung diseases. Some conditions are more prevalent in women, such as pulmonary arterial hypertension and sarcoidosis. Some life stages-such as pregnancy-are unique to women and can affect the onset and course of lung disease. Clinical presentation may differ as well, such as the higher number of exacerbations experienced by women with cystic fibrosis (CF), more fatigue in women with sarcoidosis, and more difficulty in achieving smoking cessation. Outcomes such as mortality may be different as well, as indicated by the higher mortality in women with CF. In addition, response to therapy and medication safety may also differ by sex, and yet, pharmacogenomic factors are often not adequately addressed in clinical trials. Various aspects of lung/sleep biology and pathobiology are impacted by female sex and female reproductive transitions. Differential gene expression or organ development can be impacted by these biological differences. Understanding these differences is the first step in moving toward precision medicine for all patients. This article is the second part of a state-of-the-art review of specific effects of sex and gender focused on epidemiology, disease presentation, risk factors, and management of selected lung diseases. We review the more recent literature and focus on guidelines incorporating sex and gender differences in pulmonary hypertension, CF and non-CF bronchiectasis, sarcoidosis, restless legs syndrome and insomnia, and critical illness. We also provide a summary of the effects of pregnancy on lung diseases and discuss the impact of sex and gender on tobacco use and treatment of nicotine use disorder.

Feasibility and acceptability of testing a menstrual-cycle timed smoking cessation intervention for women of reproductive age (Project Phase): Results of a pilot randomized control trial

INTRODUCTION

Menstrual phase influences cigarette smoking-related outcomes. Telephone-based cessation programs (e.g., quitlines) may incorporate the role of the menstrual cycle in an effort to tailor interventions for women.

PURPOSE

The goal of this preliminary randomized clinical trial was to examine the feasibility and acceptability of timing quit date to menstrual phase in women in a quitline setting.

METHODS

We recruited treatment-seeking women with regular menstrual cycles between the ages of 18-40 years. Participants were randomized to the follicular phase (FP; quit date set 6-8 days post onset of menses) or standard of care (SC; no menstrual timing of quit date). All participants received four weeks of nicotine replacement therapy transdermal patch concurrent with six weeks of telephone-based counseling. We explored self-reported and biochemically-verified seven-day point prevalence abstinence at end-of-treatment and three-month follow-up.

RESULTS

Participants (n = 119; FP: n = 58, SC: n = 61) were, on average, 33.4 years old and smoked 13.6 cigarettes/day. The median number of counseling sessions completed was 6 out of 6 available, and 66% of participants completed the intervention. Over 90% of participants reported they would recommend this study to friends/family. Cessation rates did not significantly vary by randomization.

CONCLUSIONS

Results of this preliminary trial indicate that timing quit date to FP is an acceptable and feasible approach to address smoking cessation in women of reproductive age. While we observed similar smoking cessation rates between groups, this preliminary study was not fully powered to determine efficacy. Therefore, the feasibility and acceptability results indicate that a fully-powered efficacy trial is warranted.

Examining service participation and outcomes from a population-level telephone-coaching service supporting changes to healthy eating, physical activity and weight: A comparison of participants with and without a mental health condition

Population-level telephone coaching services provide accessible behaviour change support for modifiable health risk behaviours. The NSW Get Healthy Information and Coaching Service® (GHS) is a free telephone-based coaching service in Australia, supporting improvements in healthy eating, physical activity and achieving or maintaining a healthy weight. This study compared measures of participation (such as program completion) and outcomes achieved immediate post-program (including changes in fruit and vegetable consumption, physical activity and weight) for GHS participants with and without a self-identified mental health condition (MHC). Secondary data analysis was conducted on service data collected at program intake and completion for individuals who enrolled in a coaching program between January 2018 and October 2019 (n = 5,629); 33% identified as having had an MHC. While those with and without an MHC had similar rates of completion, those with an MHC were less likely to complete a coaching program (31% vs 36%, p = .003). Participants with an MHC made significant positive changes to their fruit and vegetable consumption, physical activity (walking and moderate), weight and BMI, but not to waist circumference or vigorous physical activity. When comparing the magnitude of change for those with and without an MHC, individuals without made greater improvements to their weight (adjusted mean difference -0.623 kg, p = .034) and daily vegetable intake (adjusted mean difference -0.199 serves; p = .01). There were no differences for other variables. The GHS is an effective means of supporting behaviour change for people with an MHC who complete a coaching program. Further research should consider means of improving retention rates.

Characteristics of Patients Engaging in Quitline Counseling After an Electronic Referral

INTRODUCTION

Proactive, electronic referral of primary care patients to quitlines has great potential to provide evidence-based tobacco-cessation assistance to tobacco users. However, the quitline contact rates and engagement of individuals beyond 1 counseling call are poor. This study examines the characteristics of electronically referred patients who engage with the quitline.

METHODS

This cross-sectional study included 2,407 primary care patients who reported using tobacco and accepted an electronic referral to the quitline. Outcomes included contact, enrollment, and receipt of ≥2 counseling sessions from the quitline. All measures were assessed from the electronic health record. The association of patient characteristics and outcomes was evaluated using logistic regression modeling with generalized estimating equation methods. Data were collected in 2016‒2018 and were analyzed in 2020.

RESULTS

Among 2,407 referred patients, 794 (33.0%) were contacted; of those, 571 enrolled (71.9%); and of those, 240 (42.0%) engaged in ≥2 quitline counseling sessions. In multivariable analyses, older adults (aged 50-64 and ≥65 years) were significantly more likely to be contacted (OR=2.32, 95% CI=1.6, 3.4) and to receive ≥2 counseling sessions (OR=2.34, 95% CI=1.2, 4.7) than those aged 18-34 years. Those with both Medicare and Medicaid insurance coverage were more likely than those with Medicaid only to be contacted (OR=1.71, 95% CI=1.4, 2.2), to enroll (OR=1.84, 95% CI=1.2, 2.9), and to receive ≥2 counseling sessions (OR=1.83, 95% CI=1.2, 2.9).

CONCLUSIONS

The current quitline phone-based approach is less likely to engage younger adults and those with Medicaid coverage; however, there is a need to improve quitline engagement across all patients. Identification and testing of alternative engagement approaches are needed.

The Utilization of National Tobacco Cessation Services among Female Smokers and the Need for a Gender-Responsive Approach

Despite the steadily increasing prevalence of female smoking, gender-responsive tobacco cessation services have not been widely provided worldwide. The purpose of this study is to identify factors associated with the use of tobacco cessation services among female tobacco product users in Korea from a national perspective. We performed a logistic regression analysis using data from 663 female smokers; 11.0% of female smokers had used government-supported smoking cessation services. A logistic regression model showed a statistically significant association between the utilization of smoking cessation services and a history of pregnancy and childbirth, depression, current use of heated tobacco products and multiple tobacco products, parental smoking status and receiving advice to quit. With regard to the motivation ruler, those in their 50s reported a higher importance than those in their 20s. Weight gain concerns when quitting smoking were the lowest among the participants aged 19-29. The need to develop gender-specific smoking cessation programs is the highest among the participants aged 39-49 and the lowest among those aged 19-29. This study suggests several factors related to the utilization of national health services among female smokers. Further studies considering gender-specific needs for the development of gender-responsive tobacco cessation support are needed.

A comparison of quit outcomes for men and women in a smoking cessation program offering personalized nicotine replacement therapy and counselling in primary care clinics

INTRODUCTION

Women may have greater difficulty achieving long-term abstinence following a quit attempt compared to men. We sought to determine whether there were differences in treatment characteristics or outcome between female and male primary care patients enrolled in a smoking cessation program providing personalized nicotine replacement therapy (NRT) with counselling support.

METHODS

The sample included 27,601 Ontarians (53% female, 47% male) who enrolled in the Smoking Treatment for Ontario Patients program between 2016 and 2018. Dose, type, and duration of NRT supplied was personalized to need. Thirty-day point prevalence tobacco smoking abstinence was self-reported via online or telephone survey at 6 months post-enrollment.

RESULTS

Both female and male participants received a median of 8 weeks of NRT. Types of NRT received were similar, with 80% of both female and male participants receiving patch and short-acting NRT. Total cumulative dose was somewhat higher for men (1373 mg vs. 1265 mg, p<0.001); but when calculated as dose per day, per cigarette smoked at baseline, dose was slightly higher among women (1.6 mg vs. 1.5 mg, p<0.001). Quit rates at 6 months were lower for women versus men (24% vs. 27%; AOR = 0.84 [95% CI = 0.78-0.90], p<0.001). There were no significant interactions between gender and dose, type or duration of NRT supplied.

CONCLUSIONS

Women were slightly less likely to quit than men, despite receiving similar treatment. There was no evidence that women benefitted more or less from variations in dose, type or duration of NRT supply.

The Association between Quitline Characteristics and Smoking Cessation by Educational Attainment, Income, Race/Ethnicity, and Sex

Little research examines how tobacco quitlines affect disparities in smoking cessation in the United States. Our study utilized data from the Tobacco Use Supplement to the Current Population Survey (2010, 2011, 2012, 2015, 2018) (TUS-CPS) and state-level quitline data from the North American Quitline Consortium and National Quitline Data Warehouse. We ran multilevel logistic regression models assessing a state-run quitline's budget, reach, number of counseling sessions offered per caller, and hours of operation on 90-day smoking cessation. Multiplicative interactions between all exposures and sex, race/ethnicity, income, and education were tested to understand potential effect modification. We found no evidence that budget, reach, number of counseling sessions, or hours available for counseling were associated with cessation in the main effects analyses. However, when looking at effect modification by sex, we found that higher budgets were associated with greater cessation in males relative to females. Further, higher budgets and offering more sessions had a stronger association with cessation among individuals with lower education, while available counseling hours were more strongly associated with cessation among those with higher education. No quitline characteristics examined were associated with smoking cessation. We found evidence for effect modification by sex and education. Despite proven efficacy at the individual-level, current resource allocation to quitlines may not be sufficient to improve rates of cessation.

Feasibility and acceptability of testing a menstrual-cycle timed smoking cessation intervention for women of reproductive age (Project Phase): Protocol of a pilot randomized controlled trial

BACKGROUND

Compared to men, women have unique barriers to smoking cessation and are less likely to utilize quitline services. While current clinical recommendations have called for sex/gender-specific smoking cessation protocols, quitlines have not been expanded protocols to address the unique needs of women. Menstrual cycles (and/or ovarian hormones) influence quit outcomes in women. This paper presents the study design and protocol for a randomized control trial (Project Phase) designed to test the feasibility and acceptability of utilizing menstrual cycle timing to improve quit outcomes in women of reproductive age.

METHODS/DESIGN

Participants include treatment-seeking women (n = 116), between the ages of 18-40 with regular and naturally-occurring menstrual cycles. Eligible participants are randomized to either the mid-Follicular Phase (FP) or Standard Care (SC-control) group. Counseling includes six weekly telephone sessions with four weeks of nicotine replacement therapy. The timing and frequency of sessions is identical to both conditions, with the exception of the quit day (week 3 of counseling). In addition to providing education on menstrual cycle and quitting, quit day for FP participants is set within 6-8 days post onset of menses; the SC group quit day is set for Week 3 of counseling regardless of their menstrual cycle phase. Dried blood spots will be used to bioverify menstrual cycle phase and smoking status.

DISCUSSION

If feasible and acceptable, our behavioral counseling intervention that times the quit day to the mid-follicular phase of the menstrual may increase quit outcomes among women of reproductive age and has potential for dissemination across quitlines nationally.

Predictors of client retention in a state-based tobacco quitline

Introduction

Quitlines are standard care for smoking cessation; however, retaining clients in services is a problem. Little is known about factors that may predict dropout.

Aims

To examine predictors of retention while in-program and at follow-up for clients enrolling in a state quitline.

Methods

This was a retrospective analysis of quitline enrolled clients from 2011 to 2017 (N = 49,347). Client retention in-program was categorized as (a) low adherence to treatment (receiving zero coaching calls), moderate (1–2 calls), and high adherence (3+ calls). Dropout at follow-up included participants who were not reached for the 7-month follow-up.

Results

More than half the sample dropped out during treatment; 61% were not reached for follow-up. Women (odds ratio (OR) = 1.21; 95% confidence interval (CI) = [1.16, 127]) and those with high levels of nicotine dependence (OR = 1.03; 95% CI = [1.02, 1.04]) were more likely to have moderate adherence to treatment (1–2 coaching calls). Dropout at follow-up was more likely among clients who used nicotine replacement therapy (OR = 1.14; 95% CI = [1.09, 1.19]) and less likely among those who had high treatment adherence (OR = 0.41; 95% CI = [0.39, 0.42]).

Conclusion

Given the relapsing nature of tobacco use and the harms related to tobacco use, quitlines can improve their impact by offering tailored services to enhance client engagement and retention in-treatment and at follow-up.