Efficacy of smoking cessation intervention among special populations: review of the literature from 2000 to 2005

Smoking cessation interventions for Hispanic/Latino(a) adults in the USA: protocol for a systematic review and planned meta-analysis

INTRODUCTION

Hispanic smokers face multiple cultural and socioeconomic barriers to cessation that lead to prominent health disparities, including a lack of language-appropriate, culturally relevant, evidence-based smoking cessation interventions. This systematic review will examine the literature on smoking cessation interventions for Hispanic adults in the USA to assess (1) the availability of interventions, (2) the methodological quality of the studies evaluating the interventions and (3) the efficacy of the interventions.

METHODS AND ANALYSIS

A systematic literature search will be conducted, in English with no date limits, through the following databases starting at year of inception: Medical Allied Health Literature, Embase, American Psychology Association Psychology Articles, Cumulative Index to Nursing and Allied Health Literature Complete, ScienceDirect, Health & Medicine Collection and Web of Science Core Collection. Trial registries and grey literature sources will be searched to identify ongoing or unpublished studies. Literature search will be rerun prior to eventual submission of the review to ensure the inclusion of relevant studies. Quantitative studies evaluating the efficacy of a smoking cessation intervention (ie, smoking cessation as a measured outcome) for Hispanic adult smokers in the USA will be included in the systematic review. Two authors will independently identify relevant studies, extract data and conduct quality and risk of bias assessments. Discrepancies in coding will be discussed between the two reviewers and pending disagreements will be resolved by a third reviewer. First, the quality of all studies will be assessed, then randomised controlled trials (RCTs) will be further evaluated for risk of bias using Cochrane's Risk of Bias Tool. All eligible studies will be summarised descriptively. If data allow, the efficacy of smoking cessation interventions tested in RCTs, with a minimum follow-up of 6 months, will be quantitatively estimated using ORs and 95% CIs. The association between intervention type/modality and efficacy will be assessed via subgroup analyses.

PROSPERO REGISTRATION NUMBER

CRD42022291068.

A Randomized Trial of Nicotine versus No-nicotine E-cigarettes Among African American Smokers: Changes in Smoking and Tobacco Biomarkers

INTRODUCTION

The objective of this clinical trial was to compare the effects of e-cigarettes with and without nicotine on patterns of combustible cigarette use and biomarkers of exposure to tobacco toxicants among African American smokers.

METHODS

African American smokers (n = 234) were enrolled in a 12-week, single blind, randomized controlled trial and assigned to ad lib use of nicotine e-cigarettes with or without menthol (2.4% nicotine [equivalent to combustible cigarettes], n = 118), or no-nicotine e-cigarettes (n = 116) for 6 weeks. Surveys were administered at baseline, 2, 6, and 12 weeks, and urinary biomarkers 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and total nicotine equivalents (TNE) were assessed at baseline and 6 weeks.

RESULTS

Participants smoked an average of 11.4 cigarettes per day (CPD) and 88% used menthol cigarettes at baseline. At Week 6, the nicotine group reported using e-cigarettes 9.1 times per day compared to 11.4 times in the no-nicotine group (p = 0.42). Combustible cigarette smoking decreased 3.0 CPD in the nicotine group compared to 2.7 CPD in the no-nicotine group (p = 0.74). Neither TNE nor NNAL changed significantly between baseline and Week 6. There were no differences in nicotine withdrawal symptoms between treatment groups. Smoking reduction persisted in both groups at Week 12.

CONCLUSIONS

Contrary to our hypotheses, nicotine e-cigarettes did not significantly reduce the use of combustible cigarettes compared to no-nicotine e-cigarettes in this cohort of African American smokers. Findings suggest e-cigarettes are modestly associated with the decreased use of combustible cigarettes among non-treatment seeking smokers, regardless of nicotine content, but without a reduction in tobacco toxicants.

IMPLICATIONS

Although e-cigarettes have the potential to reduce harm if substituted for combusted cigarettes (or if they promoted cessation) because of lower levels of tobacco toxicants, this study suggests ad lib use of e-cigarettes among African American smokers, with or without nicotine, results in modest smoking reduction but does not change toxicant exposure in a cohort where smoking cessation or reduction is not the goal. These data suggest that testing future harm reduction interventions using e-cigarettes should include more specific behavioral change coaching, including substituting for or completely stopping combusted cigarettes.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov - NCT03084315.

A scoping review of alcohol, tobacco, and other drug use treatment interventions for sexual and gender minority populations

BACKGROUND

Alcohol, tobacco, and other drug use are among the most prevalent and important health disparities affecting sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender) populations. Although numerous government agencies and health experts have called for substance use intervention studies to address these disparities, such studies continue to be relatively rare.

METHOD

We conducted a scoping review of prevention and drug treatment intervention studies for alcohol, tobacco, and other drug use that were conducted with SGM adults. We searched three databases to identify pertinent English-language, peer-reviewed articles published between 1985 and 2019.

RESULTS

Our search yielded 71 articles. The majority focused on sexual minority men and studied individual or group psychotherapies for alcohol, tobacco, or methamphetamine use.

CONCLUSION

Our findings highlight the need for intervention research focused on sexual minority women and gender minority individuals and on cannabis and opioid use. There is also a need for more research that evaluates dyadic, population-level, and medication interventions.

Self-help smoking cessation intervention for Spanish-speaking Hispanics/Latinxs in the United States: A randomized controlled trial

BACKGROUND

Hispanic/Latinx smokers living in the United States face unique challenges in quitting smoking. This study evaluated the efficacy of a culturally relevant, Spanish-language, extended self-help smoking cessation intervention among Hispanic smokers.

METHODS

A 2-arm parallel randomized controlled trial was conducted with Hispanic/Latinx smokers living in the United States who preferred health information in Spanish and smoked 5 or more cigarettes per week. Participants were randomly allocated to receive Libre del Cigarrillo (LDC), which consisted of 11 booklets and 9 pamphlets mailed monthly over 18 months, or the usual care (UC), which was a single Spanish-language self-help booklet from the National Cancer Institute. The primary outcome was self-reported 7-day point prevalence smoking abstinence assessed 6, 12, 18, and 24 months after the baseline. Eight prespecified moderators of the intervention were evaluated. Cost-effectiveness was also evaluated. All statistical tests were 2-sided.

RESULTS

Data from all participants randomized to LDC (n = 714) or UC (n = 703) were used for analyses after multiple imputation to manage missing data. Generalized estimating equation analyses indicated that LDC abstinence rates were higher (P < .001) across all assessments. Logistic regression analyses revealed that at 24 months, the abstinence rate was greater for LDC (33.1%) than UC (24.3%; odds ratio, 1.54; 95% confidence interval, 1.18-2.02; P = .002). Men exhibited a strong intervention effect at all assessments (P values < .001), whereas the intervention effect for women was observed only at 6 and 12 months (P values < .018). In comparison with UC, the incremental cost per quitter in the LDC arm was $648.43 at 18 months and $683.93 at 24 months.

CONCLUSIONS

A culturally relevant, Spanish-language intervention was efficacious and cost-effective for smoking cessation.

LAY SUMMARY

Research is needed to develop interventions for ethnic minority smokers. The aim of the current study was to test a Spanish-language adaptation of a validated and easily implemented self-help smoking cessation intervention in a nationwide randomized controlled trial. The findings demonstrated that the intervention produced greater smoking abstinence in comparison with a standard self-help booklet. Participants also were more satisfied with the intervention, and it was cost-effective. Efforts aimed at promoting tobacco abstinence in this underserved population could have significant public health implications, including potential reductions in cancer health disparities associated with tobacco smoking.

Impact of U.S. Antismoking TV Ads on Spanish-Language Quitline Calls

INTRODUCTION

Cigarette smoking is a major preventable cause of disease and death among U.S. Hispanics. Tobacco-cessation quitlines have been shown to increase quitting among Hispanics. However, the use of quitlines by this population remains low, especially among Spanish-speaking Hispanics. This study evaluates the promotion of 1-855-DÉJELO-YA (a quitline portal that routes callers to state-specific Spanish-language services) implemented as part of the Centers for Disease Control and Prevention's national Tips From Former Smokers^® (Tips^®) campaign. Additionally, this study examines how media content impacted calls to 1-855-DÉJELO-YA.

METHODS

Using National Cancer Institute data on calls to 1-855-DÉJELO-YA from February 2013 to December 2014, multivariate linear regressions were conducted of weekly area code-level call volume as a function of media market-level Gross Rating Points for Tips Spanish-language TV ads tagged with 1-855-DÉJELO-YA. The models were adjusted for covariates, including market-level population characteristics and state fixed effects. The data were analyzed from October 2017 through April 2018.

RESULTS

Greater exposure to Tips Spanish-language ads was associated with increased calls to 1-855-DÉJELO-YA (p<0.001). On average, each additional 100 Tips Gross Rating Points per media market increased calls by 0.56 (95% CI=0.45, 0.67) calls/week/area code, representing ≅ 974 additional calls beyond the baseline. Media messages highlighting health consequences of smoking had a greater effect size than messages highlighting health effects of secondhand smoke.

CONCLUSIONS

A national Spanish-language quitline number could be a useful cessation resource for Spanish-speaking cigarette smokers. Opportunities exist to increase use of this number through a national Spanish-language media campaign, particularly by focusing campaign messages on the health consequences of smoking.

A scoping review and meta-analysis of psychosocial and pharmacological treatments for cannabis and tobacco use among African Americans

The rates of co-occurring cannabis and tobacco use are higher among African Americans relative to other racial/ethnic groups. One plausible approach to treating co-use among African Americans is to examine the effectiveness of treatments for the sole use of cannabis and tobacco to identify effective approaches that might be combined to treat the dual use of these substances. The current meta-analysis sought to include studies that reported cannabis and/or tobacco use outcomes from randomized clinical trials (RCTs) with 100% African American samples. A total of 843 articles were considered for inclusion, 29 were reviewed by independent qualitative coders, and 22 were included in the review. There were no articles on cannabis use treatment with a 100% African American sample, resulting in a need to lower the threshold (60%) and conduct a scoping review of cannabis studies. Preliminary evidence from a small number of studies (k = 7) supports the use of Motivational Interviewing and Cognitive-Behavioral Therapy to treat cannabis use among African Americans, but not Contingency Management. Results from a meta-analysis of 15 tobacco studies found higher rates of smoking abstinence in the treatment condition relative to control conditions overall and across short and long-term follow-up periods. Significant differences in smoking abstinence were also found when examining the effects of pharmacological treatments relative to their control conditions. The clinical and research implications of these findings for future psychosocial and pharmacological trials for cannabis and tobacco use and co-use among African Americans are described. (PsycINFO Database Record

LGBTQ Youth and Young Adult Perspectives on a Culturally Tailored Group Smoking Cessation Program

Introduction

The prevalence of smoking among LGBTQ youth and young adults (YYAs) is much higher than that of non-LGBTQ young people. The current study explored LGBTQ YYA perceptions of a culturally tailored group smoking cessation counselling program, along with how the intervention could be improved.

Methods

We conducted focus groups (n = 24) with 204 LGBTQ YYAs in Toronto and Ottawa, Canada. Open-ended questions focused on their feelings, likes and dislikes, concerns and additional ideas for a culturally tailored group cessation counselling intervention. Focus group transcripts were coded thematically and analyzed.

Results

Overall, YYAs were ambivalent towards the concept of a culturally tailored, group cessation counselling program. Although several participants were attracted to the LGBTQ friendly and social benefits of such a program (eg, good support system), many also had concerns. Particularly, the possibility that other group members might trigger them to smoke was a frequently stated issue. Focus group members also noted lack of motivation to attend the group, and that the group program may be inaccessible depending on where and when the program was offered. Several suggestions were made as to how to ameliorate the expressed issues related to inaccessibility or lack of attractiveness.

Conclusions

This study is among the first to gain the perspectives of LGBTQ YYAs on culturally tailored group cessation strategies in Canada. We identified components of group cessation programs that are both favored and not favored among LGBTQ YYAs, as well as suggestions as to how to make group cessation programs more appealing.

Implications

This study is particularly relevant as smoking cessation programs are one of the most commonly offered and published cessation interventions for the LGBTQ community, yet little is understood in terms of preferences of LGBTQ YYA smokers. Given the disparity in the prevalence of smoking among LGBTQ young people compared to their non-LGBTQ peers, research on effective intervention strategies for this population is needed. Findings from this study can assist practitioners and researchers in designing interventions.

Evaluation of Community-Based Cessation Programs: How Do Smokers with Behavioral Health Conditions Fare?

Though persons with behavioral health conditions experience large disparities in tobacco use, questions about the efficacy of evidence-based tobacco use treatment remain understudied in community health settings. This evaluation examined outcomes from eight community-based tobacco cessation programs for participants with and without behavioral health conditions (n = 974 participants). The majority (64.8%) of participants reported one or more current behavioral health conditions, including mental illness and/or substance abuse. Participants who used cessation medication during the program and who attended more counseling sessions had an increased likelihood of being quit at 4-month follow-up. Quit rates were between 9.8% (intent-to-treat rate) and 30.6% (responder rate); behavioral health status did not negatively affect reported quit rates. Findings add to the growing literature evaluating community-based interventions within the behavioral health population.

Evidence for a comprehensive approach to Aboriginal tobacco control to maintain the decline in smoking: an overview of reviews among Indigenous peoples

BACKGROUND

Tobacco smoking is a leading cause of disease and premature mortality among Aboriginal and Torres Strait Islander (Indigenous) Australians. While the daily smoking prevalence among Indigenous Australians has declined significantly from 49% in 2001, it remains about three times higher than that of non-Indigenous Australians (39 and 14%, respectively, for age ≥15 years in 2014-15). This overview of systematic reviews aimed to synthesise evidence about reducing tobacco consumption among Indigenous peoples using a comprehensive framework for Indigenous tobacco control in Australia comprised of the National Tobacco Strategy (NTS) and National Aboriginal and Torres Strait Islander Health Plan (NATSIHP) principles and priorities.

METHODS

MEDLINE, EMBASE, systematic review and Indigenous health databases were searched (2000 to Jan 2016) for reviews examining the effects of tobacco control interventions among Indigenous peoples. Two reviewers independently screened reviews, extracted data, and assessed review quality using Assessing the Methodological Quality of Systematic Reviews. Data were synthesised narratively by framework domain. Reporting followed the PRISMA statement.

RESULTS

Twenty-one reviews of varying quality were included. There was generally limited Indigenous-specific evidence of effective interventions for reducing smoking; however, many reviewers recommended multifaceted interventions which incorporate Indigenous leadership, partnership and engagement and cultural tailoring. Under the NTS priority areas, reviewers reported evidence for brief smoking cessation interventions and pharmacological support, mass media campaigns (on knowledge and attitudes) and reducing affordability and regulation of tobacco sales. Aspects of intervention implementation related to the NATSIHP domains were less well described and evidence was limited; however, reviewers suggested that cultural tailoring, holistic approaches and building workforce capacity were important strategies to address barriers. There was limited evidence regarding social media and mobile applications, for Indigenous youth, pregnant women and prisoners, and no evidence regarding interventions to protect communities from industry interference, the use of electronic cigarettes, interventions for people experiencing mental illness, juvenile justice, linguistic diversity or 'pubs, clubs and restaurants'.

CONCLUSIONS

There is limited Indigenous-specific evidence for most tobacco interventions. A 'comprehensive approach' incorporating NTS and NATSIHP Principles and Priorities of partnership and engagement, evidence from other settings, programme logic and responsive evaluation plans may improve intervention acceptability, effectiveness and implementation and mitigate risks of adapting tobacco evidence for Indigenous Australians.

Tobacco use cessation interventions for lesbian, gay, bisexual, transgender and queer youth and young adults: A scoping review

Smoking prevalence among LGBTQ + youth and young adults is alarmingly high compared to their non-LGBTQ + peers. The purpose of the scoping review was to assess the current state of smoking prevention and cessation intervention research for LGBTQ + youth and young adults, identify and describe these interventions and their effectiveness, and identify gaps in both practice and research.

A search for published literature was conducted in PubMed, Scopus, CINAHL, PsychInfo, and LGBT Life, as well as an in-depth search of the grey literature. All English articles published or written between January 2000 and February 2016 were extracted.

The search identified 24 records, of which 21 were included; 11 from peer reviewed sources and 10 from the grey literature. Of these 21, only one study targeted young adults and only one study had smoking prevention as an objective. Records were extracted into evidence tables using a modified PICO framework and a narrative synthesis was conducted. The evidence to date is drawn from methodologically weak studies; however, group cessation counselling demonstrates high quit rates and community-based programs have been implemented, although very little evidence of outcomes exist. Better-controlled research studies are needed and limited evidence exists to guide implementation of interventions for LGBTQ + youth and young adults.

This scoping review identified a large research gap in the area of prevention and cessation interventions for LGBTQ youth and young adults. There is a need for effective, community-informed, and engaged interventions specific to LGBTQ + youth and young adults for the prevention and cessation of tobacco.

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We conducted a scoping review on cessation programs for LGBTQ + young adults.

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A large research gap in the area of tobacco control for LGBTQ + young adults exists.

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Tobacco control interventions specific to LGBTQ + youth and young adults are needed.

A Qualitative Study of the Barriers to and Facilitators of Smoking Cessation Among Lesbian, Gay, Bisexual, and Transgender Smokers Who Are Interested in Quitting

PURPOSE

Lesbian, gay, bisexual, and transgender (LGBT) individuals are significantly more likely to smoke compared with their heterosexual and cisgender counterparts. The purpose of this study was to explore barriers to and facilitators of smoking cessation readiness among LGBT smokers.

METHODS

This descriptive study used a qualitative approach. Four 90-minute focus groups (eligibility criteria: age ≥21, self-identify as LGBT, current smoker, interest in quitting smoking) were conducted. Participants also completed a brief survey that measured additional demographic characteristics and smoking behaviors. Topics explored included quit experiences, attitudes and beliefs, barriers to and facilitators of cessation, and cultural factors related to smoking behaviors. Established qualitative methods were used to conduct the focus groups and data analysis.

RESULTS

The mean age of participants (N = 31) was 37.1 years with the majority identifying as male (58.1%). The sample group was racially diverse: 32% were African American, 39% were White, and 29% were more than one race. Interest in quitting was high (M = 9.0, range 0-10). Barriers to smoking cessation fell under the broad themes of individual-level factors, cultural factors, psychosocial factors, and access to treatment. Facilitators of smoking cessation included stage of readiness, health concerns, social stigma, a shift in social norms, financial costs, and improving dating prospects.

CONCLUSIONS

Interest in smoking cessation was high in this sample of LGBT smokers and influenced by a range of facilitators. Nevertheless, several general and culturally specific barriers to smoking cessation readiness were identified. The study results have implications for future research and the development of outreach, prevention, and treatment programs.

Disparities in tobacco use by sexual orientation among high school students

OBJECTIVE

This study examined whether cigarette use is associated with sexual orientation among high school students.

METHODS

Data were from a 2012 cross-sectional survey of 5994 students in grades 9, 10 and 12 attending public schools in Atlantic Canada. Multilevel logistic regression analysis was used to examine differences in cigarette use by sexual orientation.

RESULTS

Lesbian, gay and bisexual adolescents (LGB) reported higher prevalence (22%) of daily cigarette use compared with heterosexuals (11%). Multilevel logistic regression analysis, controlling for standard covariates, found that LGB adolescents were more likely to be daily smokers than non-LGB adolescents (odds ratio 2.00, 95% confidence interval 1.50-2.68). Bisexual adolescents were at least twice more likely to be a smoker compared with heterosexual adolescents.

CONCLUSIONS

Prevalence of cigarette use was significantly higher among LGB adolescent students. Our results join a growing body of evidence indicating that sexual minorities are at heightened risk of tobacco use. Smoking cessation measures that specifically target this group may be beneficial given that there is no one size fits all approach.

Promotion of tobacco use cessation for lesbian, gay, bisexual, and transgender people: a systematic review

CONTEXT

Lesbian, gay, bisexual, and transgender (LGBT) people are at increased risk for the adverse effects of tobacco use, given their high prevalence of use, especially smoking. Evidence regarding cessation is limited. To determine if efficacious interventions are available and to aid the development of interventions, a systematic review was conducted of grey and peer-reviewed literature describing clinical, community, and policy interventions, as well as knowledge, attitudes, and behaviors regarding tobacco use cessation among LGBT people.

EVIDENCE ACQUISITION

Eight databases for articles from 1987 to April 23, 2014, were searched. In February-November 2013, authors and researchers were contacted to identify grey literature.

EVIDENCE SYNTHESIS

The search identified 57 records, of which 51 were included and 22 were from the grey literature; these were abstracted into evidence tables, and a narrative synthesis was conducted in October 2013-May 2014. Group cessation curricula tailored for LGBT populations were found feasible to implement and show evidence of effectiveness. Community interventions have been implemented by and for LGBT communities, although these interventions showed feasibility, no rigorous outcome evaluations exist. Clinical interventions show little difference between LGBT and heterosexual people. Focus groups suggest that care is needed in selecting the messaging used in media campaigns.

CONCLUSIONS

LGBT-serving organizations should implement existing evidence-based tobacco-dependence treatment and clinical systems to support treatment of tobacco use. A clear commitment from government and funders is needed to investigate whether sexual orientation and gender identity moderate the impacts of policy interventions, media campaigns, and clinical interventions.

The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities

National health initiatives emphasize the importance of eliminating health disparities among historically disadvantaged populations. Yet, few studies have examined the range of health outcomes among lesbian, gay, bisexual, and transgender (LGBT) people. To stimulate more inclusive research in the area, we present the Health Equity Promotion Model-a framework oriented toward LGBT people reaching their full mental and physical health potential that considers both positive and adverse health-related circumstances. The model highlights (a) heterogeneity and intersectionality within LGBT communities; (b) the influence of structural and environmental context; and (c) both health-promoting and adverse pathways that encompass behavioral, social, psychological, and biological processes. It also expands upon earlier conceptualizations of sexual minority health by integrating a life course development perspective within the health-promotion model. By explicating the important role of agency and resilience as well as the deleterious effect of social structures on health outcomes, it supports policy and social justice to advance health and well-being in these communities. Important directions for future research as well as implications for health-promotion interventions and policies are offered.

Response to a mobile health decision-support system for screening and management of tobacco use

PURPOSE/OBJECTIVES

To describe the predictors of nurse actions in response to a mobile health decision-support system (mHealth DSS) for guideline-based screening and management of tobacco use.

DESIGN

Observational design focused on an experimental arm of a randomized, controlled trial.

SETTING

Acute and ambulatory care settings in the New York City metropolitan area.

SAMPLE

14,115 patient encounters in which 185 RNs enrolled in advanced practice nurse (APN) training were prompted by an mHealth DSS to screen for tobacco use and select guideline-based treatment recommendations.

METHODS

Data were entered and stored during nurse documentation in the mHealth DSS and subsequently stored in the study database where they were retrieved for analysis using descriptive statistics and logistic regressions.

MAIN RESEARCH VARIABLES

Predictor variables included patient gender, patient race or ethnicity, patient payer source, APN specialty, and predominant payer source in clinical site. Dependent variables included the number of patient encounters in which the nurse screened for tobacco use, provided smoking cessation teaching and counseling, or referred patients for smoking cessation for patients who indicated a willingness to quit.

FINDINGS

Screening was more likely to occur in encounters where patients were female, African American, and received care from a nurse in the adult nurse practitioner specialty or in a clinical site in which the predominant payer source was Medicare, Medicaid, or State Children's Health Insurance Program. In encounters where the patient payer source was other, nurses were less likely to provide tobacco cessation teaching and counseling.

CONCLUSIONS

mHealth DSS has the potential to affect nurse provision of guideline-based care. However, patient, nurse, and setting factors influence nurse actions in response to an mHealth DSS for tobacco cessation.

IMPLICATIONS FOR NURSING

The combination of a reminder to screen and integration of guideline-based recommendations into the mHealth DSS may reduce racial or ethnic disparities to screening, as well as clinician barriers related to time, training, and familiarity with resources.

Difference in adherence to and influencing factors of a healthy lifestyle between middle-aged and elderly people in Korea: A multilevel analysis

AIM

Comprehensive research for factors related to healthy lifestyles of the elderly is limited. The present study aimed to elucidate the factors associated with adherence to a healthy lifestyle by age groups.

METHOD

The present study was based on data from the 2005 Korea National Health and Nutrition Examination Survey. We calculated crude proportions and adjusted proportions of cigarette smokers, problem alcohol drinkers, and physically inactive people in two age groups (40-59 years and ≥60 years). We carried out multilevel analysis to elucidate factors associated with healthy lifestyles.

RESULTS

Of 3194 respondents included in the analysis, 1154 (36.13%) were aged 60 years or older. Older participants smoked less (23.0% vs 17.4%) and exercised less frequently (52.4% vs 66.9%; all P < 0.001) than their middle-aged counterparts. After adjustment, the proportion of regular exercisers was inversed (adjusted proportion 0.468, 95% CI 0.436-0.501 vs 0.377, 95% CI 0.337-0.419, P = 0.004). In multilevel analysis, contextual factors, such as local tax per capita, was associated significantly with cigarette smoking only in the elderly (OR 1.037, 95% CI 1.005-1.070).

CONCLUSIONS

Different factors were associated with healthy lifestyles of elderly people when compared with middle-aged people. In addition, local tax per capita, an area level variable, was more likely to be associated with smoking in the elderly than the middle-aged group.

Ethics and Community Involvement in Syntheses Concerning American Indian, Alaska Native, or Native Hawaiian Health: A Systematic Review

BACKGROUND

The objective of the research was to review reporting of ethical concerns and community involvement in peer-reviewed systematic reviews or meta-analyses concerning American Indian, Alaska Native, or Native Hawaiian (AI/AN/NH) health.

METHODS

Text words and indexed vocabulary terms were used to query PubMed, Embase, Cochrane Library, and the Native Health Database for systematic reviews or meta-analyses concerning AI/AN/NH health published in peer-reviewed journals, followed by a search through reference lists. Each article was abstracted by two independent reviewers; results were discussed until consensus was reached.

RESULTS

We identified 107 papers published from 1986-2012 that were primarily about AI/AN/NH health or presented findings separately for AI/AN/NH communities. Two reported seeking indigenous reviewer feedback; none reported seeking input from tribes and communities. Approximately 7% reported on institutional review board (IRB) approval of included studies, 5% reported on tribal approval, and 4% referenced the sovereignty of AI/AN tribes. Approximately 63% used evidence from more than one AI/AN/NH population study, and 28% discussed potential benefits to communities from the synthesis research.

CONCLUSIONS

Reporting of ethics and community involvement are not prominent. Systematic reviews and meta-analyses making community-level inferences may pose risks to communities. Future systematic reviews and meta-analyses should consider ethical and participatory dimensions of research.

Sexual orientation-related differences in tobacco use and secondhand smoke exposure among US adults aged 20 to 59 years: 2003-2010 National Health and Nutrition Examination Surveys

OBJECTIVES

We investigated sexual orientation-related differences in tobacco use and secondhand smoke (SHS) exposure in a nationally representative sample of US adults.

METHODS

The 2003-2010 National Health and Nutrition Examination Surveys assessed 11 744 individuals aged 20 to 59 years for sexual orientation, tobacco use, and SHS exposure (cotinine levels ≥ 0.05 ng/mL in a nonsmoker). We used multivariate methods to compare tobacco use prevalence and SHS exposure among gay or lesbian (n = 180), bisexual (n = 273), homosexually experienced (n = 388), and exclusively heterosexual (n = 10 903) individuals, with adjustment for demographic confounding.

RESULTS

Lesbian and bisexual women evidenced higher rates of tobacco use than heterosexual women. Among nonsmokers, SHS exposure was more prevalent among lesbian and homosexually experienced women than among heterosexual women. Nonsmoking lesbians reported greater workplace exposure and bisexual women greater household exposure than heterosexual women did. Identical comparisons among men were not significant except for lower workplace exposure among nonsmoking gay men than among heterosexual men.

CONCLUSIONS

Nonsmoking sexual-minority women are more likely to be exposed to SHS than nonsmoking heterosexual women. Public health efforts to reduce SHS exposure in this vulnerable population are needed.

Results from a community-based smoking cessation treatment program for LGBT smokers

Introduction. Little is known about lesbian, gay, bisexual, and transgender (LGBT) people's response to smoking cessation interventions. This descriptive study examined the benefits of a community-based, culturally tailored smoking cessation treatment program for LGBT smokers. Methods. A total of N = 198 LGBT individuals recruited from clinical practice and community outreach participated in group-based treatment. Sessions were based on the American Lung Association's “Freedom from Smoking Program” (ALA-FFS) and were tailored to LGBT smokers' needs. Seven-day smoking point prevalence abstinence served as the primary outcome. Results. Participants (M age = 40.5) were mostly White (70.4%) and male (60.5%) and had at least a college degree (58.4%). Forty-four percent scored in the moderate range on the Fagerström Test for Nicotine Dependence pretreatment, and 42.4% completed treatment (≥75% sessions). Higher educational attainment and use of nicotine replacement therapy (NRT) were associated with treatment completion. Self-reported quit rates were 32.3% at posttreatment assessment. Treatment attendance (OR = 2.45), use of NRT (OR = 4.24), and lower nicotine dependency (OR = 0.73) were positively associated with quitting smoking. Conclusions. Results suggest the benefits of offering LGBT smokers culturally tailored smoking cessation treatments. Future research could improve outcomes by encouraging treatment attendance and promoting NRT uptake.

Community-responsive interventions to reduce cardiovascular risk in American Indians

American Indian and Alaska Native (AI/AN) populations bear a heavy burden of cardiovascular disease (CVD), and they have the highest rates of risk factors for CVD, such as cigarette smoking, obesity, and diabetes, of any U.S. population group. Yet, few randomized controlled trials have been launched to test potential preventive interventions in Indian Country. Five randomized controlled trials were initiated recently in AI/AN communities to test the effectiveness of interventions targeting adults and/or children to promote healthy behaviors that are known to impact biological CVD risk factors. This article provides a context for and an overview of these five trials. The high burden of CVD among AI/AN populations will worsen unless behaviors and lifestyles affecting CVD risk can be modified. These five trials, if successful, represent a starting point in addressing these significant health disparities.

Comprehensive clinical care for men who have sex with men: an integrated approach

Men who have sex with men (MSM) have unique health-care needs, not only because of biological factors such as an increased susceptibility to infection with HIV and sexually transmitted infections associated with their sexual behaviour, but also because of internalisation of societal stigma related to homosexuality and gender non-conformity, resulting in depression, anxiety, substance use, and other adverse outcomes. Successful responses to the global HIV/AIDS epidemic will require the development of culturally sensitive clinical care programmes for MSM that address these health disparities and root causes of maladaptive behaviour (eg, societal homophobia). Health-care providers need to become familiar with local outreach agencies, hotlines, and media that can connect MSM with positive role models and social opportunities. Research is needed to understand how many MSM lead resilient and productive lives in the face of discrimination to develop assets-based interventions that build on community support. Optimum clinical care for sexual and gender minorities is a fundamental human right. MSM deserve to be treated with respect, and health-care providers need to interact with them in ways that promote disclosure of actionable health information.

A systematic review of the aetiology of tobacco disparities for sexual minorities

OBJECTIVE

To conduct a systematic review of the literature examining risk factors/correlates of cigarette smoking among lesbian, gay and bisexual (ie, sexual minority) populations.

METHODS

Sets of terms relevant to sexual minority populations and cigarette smoking were used in a simultaneous search of 10 databases through EBSCOhost. The search was limited to the peer-reviewed literature up to January 2011, using no geographic or language limits. For inclusion, the paper was required to: (1) have been written in English, (2) have sexual minorities (defined by either attraction, behaviour, or identity) included in the study population and (3) have examined some form of magnitude of association for risk factors/correlates of any definition of cigarette smoking. A total of 386 abstracts were reviewed independently, with 26 papers meeting all inclusion criteria. Abstracts were reviewed and coded independently by authors JB and JGLL using nine codes derived from the inclusion/exclusion criteria.

RESULTS

Studies used various measures of sexual orientation and of smoking. Risk factors that could be considered unique to sexual minorities included internalised homophobia and reactions to disclosure of sexual orientation. Some studies also indicated common smoking risk factors experienced at higher rates among sexual minorities, including stress, depression, alcohol use and victimisation.

CONCLUSIONS

This review identified risks that were associated with sexual minority status and common to the general population but experienced at potentially higher rates by sexual minorities. Government and foundation funds should be directed towards research on the origins of this disparity.

A survey of smoking prevalence and interest in quitting among social and community service organisation clients in Australia: a unique opportunity for reaching the disadvantaged

Background

Social and community service organisations (SCSOs) are non-government, not-for-profit organisations that provide welfare services to disadvantaged individuals. SCSOs hold considerable potential for providing smoking cessation support to disadvantaged smokers. This study aimed to establish the prevalence of smoking, interest in quitting and interest in receiving cessation support amongst clients accessing SCSOs.

Methods

Clients seeking financial or material assistance from three SCSOs in NSW, Australia, between February and October 2010 were invited to complete a 60-item general health touch screen computer survey. This included questions about smoking status, past quit attempts and interest in receiving support to quit smoking from SCSO staff.

Results

A total of 552 clients were approached to participate during the study period, of which 383 provided consent and completed the survey (69% consent rate). Daily smoking was reported by 53.5% of participants. Occasional smoking (non-daily smoking) was reported by a further 7.9% of participants. Most participants had tried to quit smoking in the past (77%) and had made an average of two quit attempts (SD = 3.2) lasting longer than 24 hours in the previous 12 months. More than half of all participants (52.8%) reported that they would like help from SCSO staff to quit smoking. For those interested in receiving help, the preferred types of help were access to free NRT (77%), cash rewards (52%) and non-cash rewards (47%) for quitting, and to receive support and encouragement from SCSO staff to quit (45%).

Conclusions

Smoking rates among clients accessing SCSO are substantially higher than the general population rate of 15.1%. A substantial proportion of clients are interested in quitting and want support from the SCSO to do so.

A systematic review and meta-analysis of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups

AIMS

A systematic review and meta-analysis was conducted to assess the methodological quality and effectiveness of behavioural smoking cessation interventions targeted at six disadvantaged groups; the homeless, prisoners, indigenous populations, at-risk youth, individuals with low socio-economic status and individuals with a mental illness.

METHODS

Medline, EMBASE, the Cochrane Library and PsycInfo databases were searched using MeSH and keywords for studies conducted in developed countries prior to October 2010. Included studies were assessed for methodological quality. A DerSimonian and Laird random effects meta-analysis was conducted where possible to explore the effectiveness of interventions for the different subgroups. A narrative review was conducted for studies unable to be included in the meta-analysis. Outcomes examined were abstinence rates at short-term (up to 3 months) and long-term (6 months or the longest) follow-up.

RESULTS

Thirty-two relevant studies were identified. The majority (n = 20) were rated low in methodological quality. Results of the meta-analysis showed a significant increase in cessation for behavioural support interventions targeted at low-income female smokers at short-term follow-up [relative risk (RR) 1.68, confidence interval (CI) 1.21-2.33], and behavioural support interventions targeted at individuals with a mental illness at long-term follow-up (RR 1.35, CI 1.01-1.81). Results of the narrative review showed several promising interventions that increased cessation rates at 6-month or longer follow-up.

CONCLUSIONS

Few well-controlled trials have examined the most effective smoking cessation strategies for highly disadvantaged groups, especially among the homeless, indigenous smokers and prisoners. The use of behavioural smoking cessation interventions for some socially disadvantaged groups appears promising; however, overall findings are inconsistent. Further research is needed to establish the most effective interventions for vulnerable high-risk groups. Special attention should be given to increasing sample size and power, and to sound evaluation methodology to overcome methodological limitations of conducting research with these high-risk groups.

Transcreation of validated smoking relapse-prevention booklets for use with Hispanic populations

This report describes the steps taken to develop an evidence-based series of current smoking relapse-prevention booklets for Hispanic smokers.

Smoker characteristics and smoking-cessation milestones

BACKGROUND

Contextual variables often predict long-term abstinence, but little is known about how these variables exert their effects. These variables could influence abstinence by affecting the ability to quit at all, or by altering risk of lapsing, or progressing from a lapse to relapse.

PURPOSE

To examine the effect of common predictors of smoking-cessation failure on smoking-cessation processes.

METHODS

The current study (N=1504, 58% female, 84% Caucasian; recruited from January 2005 to June 2007; data analyzed in 2009) uses the approach advocated by Shiffman et al. (2006), which measures cessation outcomes on three different cessation milestones (achieving initial abstinence, lapse risk, and the lapse-relapse transition) to examine relationships of smoker characteristics (dependence, contextual and demographic factors) with smoking-cessation process.

RESULTS

High nicotine dependence strongly predicted all milestones: not achieving initial abstinence, and a higher risk of both lapse and transitioning from lapse to complete relapse. Numerous contextual and demographic variables were associated with higher initial cessation rates and/or decreased lapse risk at 6 months post-quit (e.g., ethnicity, gender, marital status, education, smoking in the workplace, number of smokers in the social network, and number of supportive others). However, aside from nicotine dependence, only gender significantly predicted the risk of transition from lapse to relapse.

CONCLUSIONS

These findings demonstrate that (1) higher nicotine dependence predicted worse outcomes across every cessation milestone; (2) demographic and contextual variables are generally associated with initial abstinence rates and lapse risk and not the lapse-relapse transition. These results identify groups who are at risk for failure at specific stages of the smoking-cessation process, and this may have implications for treatment.

RCT of a client-centred, caseworker-delivered smoking cessation intervention for a socially disadvantaged population

BACKGROUND

Disadvantaged groups are an important target for smoking cessation intervention. Smoking rates are markedly higher among severely socially disadvantaged groups such as indigenous people, the homeless, people with a mental illness or drug and alcohol addiction, and the unemployed than in the general population. This proposal aims to evaluate the efficacy of a client-centred, caseworker delivered cessation support intervention at increasing validated self reported smoking cessation rates in a socially disadvantaged population.

METHODS/DESIGN

A block randomised controlled trial will be conducted. The setting will be a non-government organisation, Community Care Centre located in New South Wales, Australia which provides emergency relief and counselling services to predominantly government income assistance recipients. Eligible clients identified as smokers during a baseline touch screen computer survey will be recruited and randomised by a trained research assistant located in the waiting area. Allocation to intervention or control groups will be determined by time periods with clients randomised in one-week blocks. Intervention group clients will receive an intensive client-centred smoking cessation intervention offered by the caseworker over two face-to-face and two telephone contacts. There will be two primary outcome measures obtained at one, six, and 12 month follow-up: 1) 24-hour expired air CO validated self-reported smoking cessation and 2) 7-day self-reported smoking cessation. Continuous abstinence will also be measured at six and 12 months follow up.

DISCUSSION

This study will generate new knowledge in an area where the current information regarding the most effective smoking cessation approaches with disadvantaged groups is limited.

TRIAL REGISTRATION NUMBER

ISRCTN: ISRCTN85202510.

Challenges in public health research with American Indians and other small ethnocultural minority populations

As a result of the historical legacy of conquest, colonization, and cultural destruction, indigenous peoples often represent just a small segment of the population in many countries throughout the world. In the United States, American Indians/Alaska Natives are not only one of the smallest minority groups in the nation, but are also very culturally diverse. Disparities in health outcomes often occur along racial and ethnic lines, and culture can play an important role in shaping health behavior. Research on the distribution and patterning of disease and risk behaviors among population subgroups is critical for advancing evidence-based public health policy and practice. This article provides a brief overview of key challenges in conducting behavioral health research with American Indians at both community and population levels. Many of the issues raised also apply to other small ethnocultural minority groups.

Delivering smoking cessation support to disadvantaged groups: a qualitative study of the potential of community welfare organizations

Reaching disadvantaged groups for smoking cessation represents a significant challenge. Not-for-profit community service organizations (CSOs) represent a promising setting for the delivery of quit smoking support to disadvantaged smokers. However, their potential has not yet been explored. This qualitative study examined the acceptability of community service-delivered smoking cessation care. In-depth interviews and focus groups were conducted with 8 managers, 35 staff and 32 clients of CSOs between December 2008 and March 2009 in New South Wales, Australia. Discussions were audiotaped, transcribed and analysed using thematic analysis techniques. Quantitative surveys were also conducted to explore preferences for cessation support. Results showed that the acceptability of providing and receiving cessation support in the community service setting was high. Staff perceived the provision of quit support to be compatible with their role but reported barriers to providing care including competing priorities, insufficient resources and inadequate staff training. Brief intervention approaches were preferred by managers and staff, while financial incentives and access to free or subsidized nicotine replacement therapy (NRT) were desired by clients. The community service setting represents a promising access point for engaging disadvantaged smokers for cessation and further research exploring the effectiveness of support delivered in this setting is clearly warranted.

Smoking-cessation strategies for American Indians: should smoking-cessation treatment include a prescription for a complete home smoking ban?

BACKGROUND

The prevalence of cigarette smoking is particularly high among American Indian communities in the Upper Midwest.

PURPOSE

To evaluate the predictors of smoking cessation among a population-based sample of American Indians in the Upper Midwest during a quit attempt aided with nicotine replacement therapy (NRT).

METHODS

This study used the subsample of American Indian adults (n = 291, response rate = 55.4%) from a cohort study of smokers engaging in an aided NRT quit attempt. Eligible participants filled an NRT prescription between July 2005 and September 2006 through the Minnesota Health Care Programs (e.g., Medicaid). Administrative records and follow-up survey data were used to assess outcomes approximately 8 months after the NRT fill date. This analysis was conducted in 2009-2010.

RESULTS

Approximately 33% of American Indian respondents trying to quit smoking reported complete home smoking bans. Adoption of a complete home smoking ban and greater perceived advantages of NRT were cross-sectionally associated with 7-day smoking abstinence in univariate and multivariate analyses. Consistent with previous research, older age was a significant predictor of 7-day abstinence. Having a history of clinician-diagnosed anxiety in the past year was associated with decreased likelihood of 7-day abstinence in the unadjusted analysis, but not significant in multivariate analyses.

CONCLUSIONS

Results of this study suggest potential modifiable targets of interventions for future research to help American Indians quit smoking: (1) improved delivery of behavioral interventions to increase the intensity of smoking cessation treatment; (2) promotion and adoption of complete home smoking bans; and (3) education to increase awareness of the benefits of NRT.

Smoking Cessation Interventions among Hispanics in the United States: A Systematic Review and Mini Meta-Analysis

Purpose.

The leading causes of mortality among Hispanics living in the United States are smoking related. This study sought to systematically review smoking cessation interventions targeting healthy Hispanic adults living in the United States, to conduct a “mini” meta-analysis of randomized controlled trials, and to offer recommendations for future research.

Data Sources.

Studies were identified through computerized bibliographic databases (PsychINFO, PsycARTICLES, PsycFirst, MEDLINE, Science Direct, and Dissertation Abstracts Online), article reference lists, conference abstracts, and unpublished data through October 2008.

Study Inclusion and Exclusion Criteria.

Evaluation of a smoking cessation intervention among healthy U.S. Hispanic adults. Studies included in the meta-analysis were also required to be randomized controlled trials.

Data Extraction.

Twelve studies were eligible for the systematic review and five studies for the meta-analysis. Two independent raters coded each study.

Data Synthesis.

Interventions consisted of self-help, nicotine replacement therapy, and community-based interventions, as well as individual, group, and telephone counseling. There was evidence for the efficacy of smoking cessation interventions at the end of treatment (odds ratio, 1.54; 95% confidence interval, 1.09–2.16), which was attenuated in the longer term.

Conclusions.

Tobacco use among U.S. Hispanics is a growing public health concern. Smoking cessation interventions demonstrate promise among Hispanic adults living in the United States. More randomized trials evaluating tobacco interventions in this special population are warranted, with examination of the effect of cultural specificity and acculturation.

Nursing's silence on lesbian, gay, bisexual, and transgender issues: the need for emancipatory efforts

The purpose of this study was to selectively review the nursing literature for publications related to lesbian, gay, bisexual, and transgender health, using (1) a key word search of CINAHL, the database of nursing and allied health publications; (2) from the top-10 nursing journals by 5-year impact factor from 2005 to 2009, counting articles about lesbian, gay, bisexual, and transgender issues; and (3) content analysis of the articles found in those journals. Only 0.16% of articles focused on lesbian, gay, bisexual, and transgender health (8 of nearly 5000 articles) and were biased toward authors outside of the United States. We discuss the impact of this silence.

Disparities in smoking and acute respiratory illnesses among sexual minority young adults

Morbidity and mortality from cigarette smoking remain major public health issues. Particularly, smoking has been associated with increased risk of acute respiratory illnesses (ARIs). Literature indicates that lesbian, gay, and bisexual (i.e., sexual minority) persons smoke more than the general population. Additionally, young adulthood is the second-most prevalent period of smoking uptake. Given this constellation of risk correlates, the authors examined whether sexual minority young adults experience increased odds of ARIs (i.e., strep throat, bronchitis, sinus infection, and asthma). Using cross-sectional data from the Spring 2006 National College Health Assessment, prevalence estimates of smoking were generated among young adult (age range, 18-24 years) lesbian/gay, bisexual, unsure, and heterosexual college students (n = 75,164). Nested logistic regression analyses were used to examine whether smoking status mediated the risk of ARIs among sexual orientation groups. Compared with heterosexual smokers, gay/lesbian smokers were more likely to have had strep throat, and bisexual smokers were more likely to have had sinus infection, asthma, and bronchitis. Whereas smoking mediated the risk of ARI, sexual minorities still showed higher odds of ARIs after adjustment for smoking. Sexual minority young adults may experience respiratory health disparities that may be linked to their higher smoking rates, and their higher rates of smoking lend urgency to the need for cessation interventions. Future studies are needed to explore whether chronic respiratory disease caused by smoking (i.e., lung cancer, COPD, emphysema) disproportionately affect sexual minority populations.

Decreases in smoking prevalence in Asian communities served by the Racial and Ethnic Approaches to Community Health (REACH) project

OBJECTIVES

We examined trends in smoking prevalence from 2002 through 2006 in 4 Asian communities served by the Racial and Ethnic Approaches to Community Health (REACH) intervention.

METHODS

Annual survey data from 2002 through 2006 were gathered in 4 REACH Asian communities. Trends in the age-standardized prevalence of current smoking for men in 2 Vietnamese communities, 1 Cambodian community, and 1 Asian American/Pacific Islander (API) community were examined and compared with nationwide US and state-specific data from the Behavioral Risk Factor Surveillance System.

RESULTS

Prevalence of current smoking decreased dramatically among men in REACH communities. The reduction rate was significantly greater than that observed in the general US or API male population, and it was greater than reduction rates observed in the states in which REACH communities were located. There was little change in the quit ratio of men at the state and national levels, but there was a significant increase in quit ratios in the REACH communities, indicating increases in the proportions of smokers who had quit smoking.

CONCLUSIONS

Smoking prevalence decreased in Asian communities served by the REACH project, and these decreases were larger than nationwide decreases in smoking prevalence observed for the same period. However, disparities in smoking prevalence remain a concern among Cambodian men and non-English-speaking Vietnamese men; these subgroups continue to smoke at a higher rate than do men nationwide.

Queer quit: gay smokers' perspectives on a culturally specific smoking cessation service

BACKGROUND

The prevalence of smoking is high among gay males. The need for culturally specific support has been acknowledged, but little is known about gay men's perspectives on such adapted interventions.

OBJECTIVE

To investigate smoking and intention to quit in gay smokers and to explore their attitudes towards a gay-specific smoking cessation programme.

DESIGN

Quantitative survey and focus groups.

SETTING AND PARTICIPANTS

A total of 325 gay smokers living in Zurich (Switzerland) completed an anonymous survey. Thirteen males participated in two focus groups, theoretically sampled to reflect heterogeneity in terms of age, HIV serostatus and smoking histories. Participants were personally recruited at a variety of events and through advertisements.

RESULTS

Responders reported high consumption of cigarettes, and every second man stated that more than half of his gay friends smoke regularly. The majority planned their quit within the next 6 months. Idealizing attitudes towards smoking were very common. Men stated strong preferences towards a culturally adapted cessation programme for gay men. Higher age, high nicotine dependence, intention to quit, smoking stereotypes and fears for weight gain were significant predictors for interest in participation in the programme. Qualitative results indicate that men felt torn between their wish for support, bonding, and community alternatives to the 'smoking gay' environment and fears for failure and loss of reputation.

CONCLUSIONS

Gay men reported likely use of a gay-specific intervention. Such interventions may offer support in abstaining from smoking, without abstaining from gay social life. Health-care providers play an important role in communicating the serious threats caused by smoking to gay men.