How does rate of smoking cessation vary by age, gender and social grade? Findings from a population survey in England

Smoking cessation rate and predictors of successful quitting in Jordan: A cross-sectional study

Tobacco smoking in Jordan is the highest in the Middle East, with health consequences and economic burdens. Smoking cessation improves health and grows the economy. This study aimed to determine the prevalence of smoking cessation in Jordan and to identify the determinants of effective quitting. This cross-sectional study was conducted using an online survey directed towards the general population of Jordan. The questionnaire was formulated in Arabic and inquired about sociodemographic factors, health status, behaviors, smoking habits, previous quitting attempts, utilization of smoking cessation services, attitudes towards quitting, and barriers to quitting. Data were analyzed using Statistical Package for Social Science version 25. A total of 463 participants were included in this study. Twenty-one percent of them were ex-smokers (n = 97), 86% were male, 63.3% were from the middle governorates, and 29.2% were 24 years old or younger. The rate of sustained quitting for at least 3 months among participants was 13.6%. The factors associated with successful quitting included age > 50 years (P = .001), practicing regular physical activity (P = .003), using more than 1 tobacco product (P = .000), smoking waterpipes or e-cigarettes (P = .000 and .015, respectively), lower levels of nicotine dependence (P = .009), duration of smoking (P = .000), higher number of smoking cessation attempts (P = .000), having 1 or more chronic diseases (P = .049), and having DM (P = .003). More than half of the ex-smokers needed 2 to 5 attempts before successfully quitting smoking. There was a low rate of utilization of smoking cessation services and medications in both groups. On the other hand, there is a high rate of use of other smoking methods, particularly waterpipes and e-cigarettes, as an aid for quitting. Current smokers reported being in a stressful situation as a barrier to quitting significantly more often than did ex-smokers (P = .013). Both groups had moderately positive attitudes toward quitting. Ex-smokers had significantly better attitudes toward their ability to manage stress, weight gain, and increased appetite after quitting (P = .004, .004, and .007, respectively). This study provides valuable insights into the complex dynamics of smoking behavior, cessation attempts, and attitudes. These findings can inform the development of targeted smoking cessation programmes and policies.

Efficacy of a Smoking Cessation Program for Underserved Ethnic Minority Communities: Results of a Smoking Cessation Trial

Objectives: Using a participatory research approach, this study reports the efficacy of the Communities Engaged and Advocating for a Smoke-free Environment (CEASE)-4 intervention offered by the local peers. Methods: CEASE-4 is a theory-based tobacco-cessation intervention, tailored to the needs of underserved populations. 842 tobacco users self-selected into: a) self-help (n = 472), b) single-session class (n = 163), and c) four-session class (n = 207). While self-help group only received educational materials, curriculum for other arms was built on the social cognitive, motivational interviewing, and trans-theoretical- frameworks. Participants could also receive nicotine replacement therapy (NRT). Outcome was self-reported smoking cessation measured 12 weeks after completion of the intervention, validated by exhaled carbon monoxide (CO) test. Results: Quit rate was statistically different across groups, with highest quit rate in four-session and lowest quit rate in self-help arm. Cessation rates at follow up (12 weeks after completion of the intervention) were 2.3% in the self-help arm, 6.1% in the single-session arm and 13.0% in the four-session arm. Conclusion: While theory-based smoking cessation services are effective for underserved populations, four-session curriculum might be superior to a single session program.

Vaping and socioeconomic inequalities in smoking cessation and relapse: a longitudinal analysis of the UK Household Longitudinal Study

BACKGROUND

Smoking is a key cause of socioeconomic health inequalities. Vaping is considered less harmful than smoking and has become a popular smoking cessation aid, and therefore has potential to reduce inequalities in smoking.

METHODS

We used longitudinal data from 25 102 participants in waves 8-10 (2016 to early 2020) of the UK Household Longitudinal Study to examine how vaping affects socioeconomic inequalities in smoking cessation and relapse. Marginal structural models were used to investigate whether vaping mediates or moderates associations between educational attainment and smoking cessation and relapse over time. Multiple imputation and weights were used to adjust for missing data.

RESULTS

Respondents without degrees were less likely to stop smoking than those with a degree (OR: 0.65; 95% CI 0.54-0.77), and more likely to relapse (OR: 1.74; 95% CI 1.37-2.22), but this inequality in smoking cessation was not present among regular vapers (OR: 0.99; 95% CI 0.54-1.82). Sensitivity analyses suggested that this finding did not hold when comparing those with or without any qualifications. Inequalities in smoking relapse did not clearly differ by vaping status.

CONCLUSIONS

Vaping may be especially helpful as a cessation aid for smokers without degree level education and therefore may help reduce inequalities in smoking. Nevertheless, other supports or aids may be needed to reach the most disadvantaged (ie, those with no qualifications) and to help people avoid relapse after cessation, though we did not find clear evidence suggesting that vaping would increase inequalities in relapse.

Gender Differences Among Out-of-School Korean Adolescents in a Counselor-Visiting Smoking Cessation Program

ABSTRACT

The purpose of this study was to explore the determinants of self-reported smoking cessation among out-of-school Korean adolescents who participated in a counselor-visiting smoking cessation program. This retrospective descriptive study analyzed data from the Korea Health Promotion Institute. Participants were enrolled between June 1, 2015, and December 31, 2017, at a regional smoking cessation center in a counselor-visiting smoking cessation program for out-of-school adolescents. Participants consisted of 807 adolescents (70.3% male) with a mean age of 16.9 ± 1.2 years. Multiple logistic regression analysis showed that female gender (OR = 1.54-1.92), cohort year 2016 (OR = 1.69-1.90), smoking more than half a pack a day (OR = 0.44-0.50), strong motivation to quit (OR = 1.44), and number of counseling in person (OR = 1.97-2.10) were statistically significant independent contributors to quitting, based on follow-up assessments at 4 weeks, 12 weeks, and 6 months. This study explored smoking cessation outcomes of a government-driven smoking cessation program that targeted out-of-school adolescents and identified several risk factors that affect a successful outcome. More research is necessary to evaluate the efficacy of such smoking cessation programs for marginalized or understudied populations.

Rare genetic variants explain missing heritability in smoking

Common genetic variants explain less variation in complex phenotypes than inferred from family-based studies, and there is a debate on the source of this 'missing heritability'. We investigated the contribution of rare genetic variants to tobacco use with whole-genome sequences from up to 26,257 unrelated individuals of European ancestries and 11,743 individuals of African ancestries. Across four smoking traits, single-nucleotide-polymorphism-based heritability ([Formula: see text]) was estimated from 0.13 to 0.28 (s.e., 0.10-0.13) in European ancestries, with 35-74% of it attributable to rare variants with minor allele frequencies between 0.01% and 1%. These heritability estimates are 1.5-4 times higher than past estimates based on common variants alone and accounted for 60% to 100% of our pedigree-based estimates of narrow-sense heritability ([Formula: see text], 0.18-0.34). In the African ancestry samples, [Formula: see text] was estimated from 0.03 to 0.33 (s.e., 0.09-0.14) across the four smoking traits. These results suggest that rare variants are important contributors to the heritability of smoking.

Gender Differences in Smoking Initiation and Cessation Associated with the Intergenerational Transfer of Smoking across Three Generations: The Nagahama Study

Global tobacco policies lowered overall and male smoking rates, but female smoking rates have remained unchanged. Parent-child studies revealed the effects of parental smoking, but gender differences had mixed results. We investigated the effects of long-term smoking behavior in families over three generations in order to clarify gender differences. A cross-sectional study in a community-based genome cohort was conducted using a self-reported questionnaire. A total of 8652 respondents were stratified by gender regarding smoking initiation. A logistic regression analysis was performed to analyze the family smoking history. A total of 2987 current smokers and ever-smokers were compared regarding smoking cessation. With respect to smoking initiation, women were affected by their smoking mothers (odds ratio (OR), 2.4; 95% confidence interval (CI), 1.8-3.2) and grandmothers (OR, 1.7; CI, 1.1-2.4). Women who continued smoking were affected only by their smoking mothers (OR, 1.6; CI, 1.05-2.49). In conclusion, gender differences in smoking initiation and cessation are possibly associated with family smoking history. Mothers and grandmothers were shown to have a strong influence on women with respect to both smoking initiation and cessation. Future research should focus on providing evidence for effective gender-specific intervention programs to curb long-term smoking in women.

The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Factors Related to Smoking Cessation

BACKGROUND

Smoking cessation is not an easy accomplishment. However, the benefits are several for those who do it, such as cardiovascular risk reduction 1 year after quitting smoking. This study aimed to verify the factors related to smoking cessation in civil servants of The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

METHODS

This study had a longitudinal design using data from a prospective cohort of civil servants (ELSA-Brasil). Our variable of interest was smoking cessation. The relationship between socio-demographic characteristics, job stress, health-related variables, legislation, and smoking cessation was analyzed by Cox proportional hazard models. The analyses were stratified by gender. Second-hand smoke exposure, age, education, excessive alcohol consumption, common mental disorder, and smoking control law were the variables considered in the final model.

RESULTS

Information of 2020 women and 2429 men was analyzed. Individuals without second-hand smoke exposure, with up to 49 years of age, with higher education, without excessive alcohol consumption, without common mental disorders, and who initiated smoking in 1989 or after the smoking control law had a higher risk of stopping smoking. The risks magnitudes were higher for women.

CONCLUSIONS

Our study reinforces the necessity of alcohol consumption regulation, the relevance of Public Health Policies, and the need for more smoking cessation measures focused on men, on people with mental disorders, alcoholism, and older adults. Also, our results did not show significant risks regarding the psychosocial working environment.

Smokers' Perceptions of Incentivized Smoking Cessation Programs: Examining How Payment Thresholds Change With Income

INTRODUCTION

Studies demonstrate that financial incentive programs increase smoking cessation. However, there is little guidance on which incentive magnitudes will ensure optimal enrollment and motivation levels. This study investigates current smokers' perceptions of varying incentive magnitudes to identify whether there is evidence for optimal amount(s) and whether perceptions differ by income group.

METHODS

Studies 1 (N = 56) and 2 (N = 147) were conducted online via Prolific.co. Current smokers were randomly shown multiple hypothetical incentive programs that differed only in the incentive amount offered. For each program, smokers rated its appeal and their likelihood of enrolling and predicted their motivation to quit if enrolled. Growth models were used to investigate the relationship between perspectives and the incentive amount.

RESULTS

An increasing quadratic trend in smokers' perceptions of programs as the incentive amount increased was identified. Incentive amounts beyond approximately £50-75 per week (£500-£750 total) did not significantly alter perceptions of programs. In Study 2, high-income smokers found programs significantly less appealing and motivating than low-income smokers, although no significant between-group differences were observed in the likelihood of enrollment. No significant differences were observed between low- and middle-income smokers.

CONCLUSIONS

Increasing the incentive amount increased smoker's perceptions of programs. This relationship was curvilinear, meaning there may be a point beyond which further increasing the amount will not improve enrollment or motivation levels. Incentives appear equally appealing to low- and middle-income smokers; the population among whom smoking is most prevalent. Future research could explore other elements of program design and whether findings hold under real-world conditions.

IMPLICATIONS

While acknowledging that they work, policymakers frequently request information about the monetary amount needed for incentive programs to be effective, and if this differs by income level. We investigated these questions using smokers' perceptions of hypothetical cessation programs that differed in the amount offered. An increasing quadratic trend in perceptions of programs by the amount and potential cut points was observed, suggesting a point may exist beyond which increasing the incentive will not improve perceptions of programs or enrollment levels. High-income smokers may not perceive incentives to be as appealing as other income groups, but appear equally willing to enroll.

Nicotine preloading for smoking cessation: the Preloading RCT

BACKGROUND

Nicotine preloading means using nicotine replacement therapy prior to a quit date while smoking normally. The aim is to reduce the drive to smoke, thereby reducing cravings for smoking after quit day, which are the main cause of early relapse. A prior systematic review showed inconclusive and heterogeneous evidence that preloading was effective and little evidence of the mechanism of action, with no cost-effectiveness data.

OBJECTIVES

To assess (1) the effectiveness, safety and tolerability of nicotine preloading in a routine NHS setting relative to usual care, (2) the mechanisms of the action of preloading and (3) the cost-effectiveness of preloading.

DESIGN

Open-label randomised controlled trial with examination of mediation and a cost-effectiveness analysis.

SETTING

NHS smoking cessation clinics.

PARTICIPANTS

People seeking help to stop smoking.

INTERVENTIONS

Nicotine preloading comprised wearing a 21 mg/24 hour nicotine patch for 4 weeks prior to quit date. In addition, minimal behavioural support was provided to explain the intervention rationale and to support adherence. In the comparator group, participants received equivalent behavioural support. Randomisation was stratified by centre and concealed from investigators.

MAIN OUTCOME MEASURES

The primary outcome was 6-month prolonged abstinence assessed using the Russell Standard. The secondary outcomes were 4-week and 12-month abstinence. Adverse events (AEs) were assessed from baseline to 1 week after quit day. In a planned analysis, we adjusted for the use of varenicline (Champix^®; Pfizer Inc., New York, NY, USA) as post-cessation medication. Cost-effectiveness analysis took a health-service perspective. The within-trial analysis assessed health-service costs during the 13 months of trial enrolment relative to the previous 6 months comparing trial arms. The base case was based on multiple imputation for missing cost data. We modelled long-term health outcomes of smoking-related diseases using the European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) model.

RESULTS

In total, 1792 people were eligible and were enrolled in the study, with 893 randomised to the control group and 899 randomised to the intervention group. In the intervention group, 49 (5.5%) people discontinued preloading prematurely and most others used it daily. The primary outcome, biochemically validated 6-month abstinence, was achieved by 157 (17.5%) people in the intervention group and 129 (14.4%) people in the control group, a difference of 3.02 percentage points [95% confidence interval (CI) -0.37 to 6.41 percentage points; odds ratio (OR) 1.25, 95% CI 0.97 to 1.62; p = 0.081]. Adjusted for use of post-quit day varenicline, the OR was 1.34 (95% CI 1.03 to 1.73; p = 0.028). Secondary abstinence outcomes were similar. The OR for the occurrence of serious AEs was 1.12 (95% CI 0.42 to 3.03). Moderate-severity nausea occurred in an additional 4% of the preloading group compared with the control group. There was evidence that reduced urges to smoke and reduced smoke inhalation mediated the effect of preloading on abstinence. The incremental cost-effectiveness ratio at the 6-month follow-up for preloading relative to control was £710 (95% CI -£13,674 to £23,205), but preloading was dominant at 12 months and in the long term, with an 80% probability that it is cost saving.

LIMITATIONS

The open-label design could partially account for the mediation results. Outcome assessment could not be blinded but was biochemically verified.

CONCLUSIONS

Use of nicotine-patch preloading for 4 weeks prior to attempting to stop smoking can increase the proportion of people who stop successfully, but its benefit is undermined because it reduces the use of varenicline after preloading. If this latter effect could be overcome, then nicotine preloading appears to improve health and reduce health-service costs in the long term. Future work should determine how to ensure that people using nicotine preloading opt to use varenicline as cessation medication.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN33031001.

FUNDING

This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 41. See the NIHR Journals Library website for further project information.

Smoking Status at Diagnosis and Subsequent Smoking Cessation: Associations With Corticosteroid Use and Intestinal Resection in Crohn's Disease

BACKGROUND

The impact of smoking at diagnosis and subsequent smoking cessation on clinical outcomes in Crohn's disease (CD) has not been evaluated in a population-based cohort.

METHODS

Using a nationally representative clinical research database, we identified incident cases of CD between 2005 and 2014. We compared the following outcomes: overall corticosteroid (CS) use; flares requiring CS; CS dependency and intestinal surgery between smokers and non-smokers at time of CD diagnosis. Differences in these outcomes were also compared between persistent smokers and smokers who quit within 2 years of diagnosis.

RESULTS

We identified 3553 patients with a new CD diagnosis over the study period of whom 1121 (32%) were smokers. Smokers at CD diagnosis had significantly higher CS-use (56 versus 47%, p < 0.0001), proportionally more CS flares (>1 CS flare/year: 9 versus 6%, p < 0.0001), and higher CS dependency (27 versus 21%, p < 0.0001) than non-smokers. Regression analysis identified smoking at diagnosis to be associated with a higher risk of intestinal surgery (HR 1.64, 95% CI 1.16-2.52). There was a significantly higher proportion of 'quitters' who remained steroid-free through follow-up in comparison to 'persistent smokers' (45.4 versus 37.5%, respectively, p = 0.02). 'Quitters' also had lower rates of CS dependency compared to 'persistent smokers' (24 versus 33%, p = 0.008).

CONCLUSIONS

Smokers at CD diagnosis have higher CS-use, CS dependency and higher risk of intestinal surgery. Quitting smoking appears to have beneficial effects on disease related outcomes, including reducing CS dependency highlighting the importance of offering early smoking cessation support.

Effects on abstinence of nicotine patch treatment before quitting smoking: parallel, two arm, pragmatic randomised trial

OBJECTIVE

To examine the effectiveness of a nicotine patch worn for four weeks before a quit attempt.

DESIGN

Randomised controlled open label trial.

SETTING

Primary care and smoking cessation clinics in England, 2012-15.

PARTICIPANTS

1792 adults who were daily smokers with tobacco dependence. 899 were allocated to the preloading arm and 893 to the control arm.

INTERVENTIONS

Participants were randomised 1:1, using concealed randomly permuted blocks stratified by centre, to either standard smoking cessation pharmacotherapy and behavioural support or the same treatment supplemented by four weeks of 21 mg nicotine patch use before quitting: "preloading."

MAIN OUTCOME MEASURES

The primary outcome was biochemically confirmed prolonged abstinence at six months. Secondary outcomes were prolonged abstinence at four weeks and 12 months.

RESULTS

Biochemically validated abstinence at six months was achieved by 157/899 (17.5%) participants in the preloading arm and 129/893 (14.4%) in the control arm: difference 3.0% (95% confidence interval -0.4% to 6.4%), odds ratio 1.25 (95% confidence interval 0.97 to 1.62), P=0.08 in the primary analysis. There was an imbalance between arms in the frequency of varenicline use as post-cessation treatment, and planned adjustment for this gave an odds ratio for the effect of preloading of 1.34 (95% confidence interval 1.03 to 1.73), P=0.03: difference 3.8% (0.4% to 7.2%). At four weeks, the difference in prolonged abstinence unadjusted for varenicline use was odds ratio 1.21 (1.00 to 1.48), difference 4.3% (0.0% to 8.7%), P=0.05, and adjusted for varenicline use was 1.32 (1.08 to 1.62) P=0.007. At 12 months the odds ratio was 1.28 (0.97 to 1.69), difference 2.7% (-0.4% to 5.8%), P=0.09 unadjusted for varenicline use and after adjustment was 1.36 (1.02 to 1.80) P=0.04. 5.9% of participants discontinued preloading owing to intolerance. Gastrointestinal symptoms-chiefly nausea-occurred in 4.0% (2.2% to 5.9%) more people in the preloading arm than control arm. Eight serious adverse events occurred in the preloading arm and eight in the control arm (odds ratio 0.99, 0.36 to 2.75).

CONCLUSIONS

Evidence was insufficient to confidently show that nicotine preloading increases subsequent smoking abstinence. The beneficial effect seems to have been masked by a concurrent reduction in the use of varenicline in people using nicotine preloading, and future studies should explore ways to mitigate this unintended effect.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN33031001.

Comparison of Postoperative Smoking Cessation Rates of Patients with Benign or Premalignant Vocal Cord Lesions

Objectives:

It has been determined that cigarette is a risk factor for squamous cell carcinomas of the oral cavity, esophagus, and larynx. We aimed to investigate the role of histopathological diagnosis of the lesion in smoker patients with vocal cord lesion on smoking cessation rates and to determine strategies to help them quit smoking.

Methods:

In this prospective clinical study, we included 182 (112 male, 70 female) smoker patients who underwent direct laryngoscopy and biopsy due to premalignant (dysplasia) or benign (polyp, leukoplasia, nodule) vocal cord lesions between July 2014 and December 2017 at our clinic. Smoking habits (ex-smoker, current smoker) of all smoker patients were questioned at least 6 months postoperatively, and postoperative smoking cessation rates were compared.

Results:

When the smoking cessation rates of the patients with benign and premalignant vocal cord lesions were evaluated, the smoking cessation rate of the patients with premalignant vocal cord lesions was 3.45 times higher than that of the patients with benign vocal cord lesions (OR, 3.45; 95% CI, 1.76–6.74) (p<0.001). The postoperative application rate of the patients to smoking cessation outpatient clinics was low (6%). Male patients with premalignant lesions were more likely to quit smoking than female patients (p=0.001).

Conclusion:

Patients with premalignant vocal cord lesions had higher smoking cessation rates. Premalignant vocal cord lesions require clinical follow-up and treatment because of the risk and potential for their transformation into in situ or invasive laryngeal carcinomas.

Impact and Effectiveness of a Stand-Alone NRT Starter Kit in a Statewide Tobacco Cessation Program

PURPOSE

To examine 2-week nicotine replacement therapy (NRT) starter kit quit outcomes and predictors and the impact of adding this new service on treatment reach.

DESIGN

Observational study of a 1-year cohort of QUITPLAN Services enrollees using registration and utilization data and follow-up outcome survey data of a subset of enrollees who received NRT starter kits.

SETTING

ClearWay Minnesota's QUITPLAN Services provides a quit line that is available to uninsured and underinsured Minnesotans and NRT starter kits (a free 2-week supply of patches, gum, or lozenges) that are available to all Minnesota tobacco users.

PARTICIPANTS

A total of 15 536 adult QUITPLAN Services enrollees and 818 seven-month follow-up survey NRT starter kit respondents.

MEASURES

Treatment reach for all services and tobacco quit outcomes and predictors for starter kit recipients.

ANALYSIS

Descriptive analyses, χ² analyses, and logistic regression.

RESULTS

Treatment reach increased 3-fold after adding the 2-week NRT starter kit service option to QUITPLAN Services compared to the prior year (1.86% vs 0.59%). Among all participants enrolling in QUITPLAN services during a 1-year period, 83.8% (13 026/15 536) registered for a starter kit. Among starter kit respondents, 25.6% reported being quit for 30 days at the 7-month follow-up. After controlling for other factors, using all NRT and selecting more cessation services predicted quitting.

CONCLUSION

An NRT starter kit brought more tobacco users to QUITPLAN services, demonstrating interest in cessation services separate from phone counseling. The starter kit produced high quit rates, comparable to the quit line in the same time period. Cessation service providers may want to consider introducing starter kits to reach more tobacco users and ultimately improve population health.

Examining Smoking Cessation in a Community-Based Versus Clinic-Based Intervention Using Community-Based Participatory Research

Tobacco use remains a major public health problem in the U.S. disproportionately affecting underserved communities. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) initiative is an intervention to address the problem using a community-based participatory research (CBPR) approach. This study compares quit rates in a peer-led community-based intervention with those achieved in a clinical setting. The intervention consisted of three Phases. Phase I (n = 404) was a clinic-based trial comparing two types of counseling. Phase II (n = 398) and Phase III (n = 163) interventions were conducted in community venues by trained Peer Motivators. Quit rates at 12-week follow-up increased from 9.4 % in Phase I (clinic-based) to an average of 23.7 % in Phases II and III combined (community-based). The main predictor of smoking cessation was delivery of services in community settings (OR 2.6, 95 % CI 1.7-4.2) while controlling for possible confounders. A community-based approach can significantly guide and improve effectiveness and acceptability of smoking cessation services designed for low-income urban populations. In addition, CBPR can result in better recruitment and retention of the participants.

Delay discounting and impulsivity traits in young and older gambling disorder patients

BACKGROUND

Impulsivity is understood to be a multidimensional construct involving aspects such as impulsive choice and impulsive traits. Delay discounting, the tendency to place greater value in immediate rewards over larger, long-term rewards, has been associated with maladaptive choices in gambling disorder (GD). Delay discounting is known to evolve with age; though no study to date has evaluated the interactions between impulsivity, GD severity and age in treatment-seeking patients.

OBJECTIVES

We aimed to examine whether associations between delay discounting and impulsivity traits differed between younger and older-aged GD patients. Secondly, we sought to untangle the mediating role of impulsivity in determining gambling behavior in these two age groups.

METHODS

GD patients (N=335) were evaluated using the UPPS-P Impulsive Behavior Scale and a delay discounting task. Structural Equation Modeling (SEM) was used to explore associations between impulsivity measures and gambling severity in young (18-30years) and old (31-70) GD patients.

RESULTS

No differences in delay discounting were found between young and old GD patients. Significant correlations between delay discounting and urgency levels (the tendency to act rashly under emotional states) were identified only in the young GD group. Path analyses also revealed both positive and negative urgency to be a mediator of GD severity levels in young GD patients.

DISCUSSION AND CONCLUSIONS

Significant associations between impulsive choice and positive urgency are only present in young gamblers, suggesting that positive urgency influence choice behavior to a greater degree at younger ages. Implications for targeted interventions are discussed.

Effectiveness of the Gold Standard Programme compared with other smoking cessation interventions in Denmark: a cohort study

OBJECTIVES

We compared the effectiveness of the Gold Standard Programme (a comprehensive smoking cessation intervention commonly used in Denmark) with other face-to-face smoking cessation programmes in Denmark after implementation in real life, and we identified factors associated with successful quitting.

DESIGN

Prospective cohort study.

SETTING

A total of 423 smoking cessation clinics from different settings reported data from 2001 to 2013.

PARTICIPANTS

In total, 82 515 patients were registered. Smokers ≥15 years old and attending a programme with planned follow-up were included. Smokers who did not want further contact, who intentionally were not followed up or who lacked information about the intervention they received were excluded. A total of 46 287 smokers were included.

INTERVENTIONS

Various real-life smoking cessation interventions were identified and compared: The Gold Standard Programme, Come & Quit, crash courses, health promotion counselling (brief intervention) and other interventions.

MAIN OUTCOME

Self-reported continuous abstinence for 6 months.

RESULTS

Overall, 33% (11 184) were continuously abstinent after 6 months; this value was 24% when non-respondents were considered smokers. The follow-up rate was 74%. Women were less likely to remain abstinent, OR 0.83 (CI 0.79 to 0.87). Short interventions were more effective among men. After adjusting for confounders, the Gold Standard Programme was the only intervention with significant results across sex, increasing the odds of abstinence by 69% for men and 31% for women. In particular, compliance, and to a lesser degree, mild smoking, older age and not being disadvantaged were associated with positive outcomes for both sexes. Compliance increased the odds of abstinence more than 3.5-fold.

CONCLUSIONS

Over time, Danish smoking cessation interventions have been effective in real life. Compliance is the main predictor of successful quitting. Interestingly, short programmes seem to have relatively strong effects among men, but the absolute numbers are very small. Only the comprehensive Gold Standard Programme works across sexes.

Gender difference and effect of pharmacotherapy: findings from a smoking cessation service

BACKGROUND

Smoking cessation services are available in England to provide assistance to those wishing to quit smoking. Data from one such service were analysed in order to investigate differences in quit rate between males and females prescribed with different treatments.

METHODS

A logistic regression model was fitted to the data using the binary response of self-reported quit (failed attempt = 0, successful attempt = 1), validated by Carbon Monoxide (CO) monitoring, 4 weeks after commencing programme. Main effects fitted were: client gender; age; region; the type of advisory sessions; and pharmacotherapy, Nicotine Replacement Therapy (NRT) or Varenicline. A second model was fitted including all main effects plus two-way interactions except region. These models were repeated using 12-week self-reported quit as the outcome.

RESULTS

At 4 weeks, all main effects were statistically significant, with males more likely (odds ratio and 95 % CI, females v males = 0.88 [0.79-0.97]), older smokers more likely (adjusted odds ratios [OR] and 95 % confidence interval [CI] respectively for groups 20-29, 30-49, 50-69 and 70+ vs 12-19 age group: 1.79 [1.39-2.31], 2.12 [1.68-2.68], 2.30 [1.80-2.92] and 2.47 [1.81-3.37] and for overall difference between groups, χ2(4) = 53.5, p < 0.001) and clients being treated with Varenicline more likely to have successfully quit than those on NRT (adjusted OR and 95 % CI for Varenicline vs NRT = 1.41 [1.21-1.64]). Statistically significant interactions were observed between (i) gender and type of counselling, and (ii) age and type of counselling. Similar results were seen in relation to main effects at 12 weeks except that type of counselling was non-significant. The only significant interaction at this stage was between gender and pharmacotherapy (adjusted OR and 95 % CI for females using Varenicline versus all other groups = 1.43 [1.06-1.94]).

CONCLUSION

Gender and treatment options were identified as predictors of abstinence at both 4 and 12 weeks after quitting smoking. Furthermore, interactions were observed between gender and (i) type of counselling received (ii) pharmacotherapy. In particular, the quit rate in women at 12 weeks was significantly improved in conjunction with Varenicline use. These findings have implications for service delivery.

Increasing reach by offering choices: Results from an innovative model for statewide services for smoking cessation

Although state quitlines provide free telephone counseling and often include nicotine replacement therapy (NRT), reach remains limited (1-2% in most states). More needs to be done to engage all smokers in the quitting process. A possible strategy is to offer choices of cessation services through quitlines and to reduce registration barriers. In March 2014, ClearWay Minnesota^SM implemented a new model for QUITPLAN® Services, the state's population-wide cessation services. Tobacco users could choose the QUITPLAN® Helpline or one or more Individual QUITPLAN® Services (NRT starter kit, text messaging, email program, or quit guide). The program website was redesigned, online enrollment was added, and a new advertising campaign was created and launched. In 2014-2015, we evaluated whether these changes increased reach. We also assessed quit attempts, quit outcomes, predictors of 30-day abstinence, and average cost per quit via a seven-month follow-up survey. Between March 2014-February 2015, 15,861 unique tobacco users registered, which was a 169% increase over calendar year 2013. The majority of participants made a quit attempt (83.7%). Thirty-day point prevalence abstinence rates (responder rates) were 26.1% for QUITPLAN Services overall, 29.6% for the QUITPLAN Helpline, and 25.5% for Individual QUITPLAN Services. Several variables predicted quit outcomes, including receiving only one call from the Helpline and using both the Helpline and the NRT starter kit. Providing greater choice of cessation services and reducing registration barriers have the potential to engage more tobacco users, foster more quit attempts, and ultimately lead to long-term cessation and reductions in prevalence.

Gender Differences in Outcome of an Attempt to Stop Smoking Among Smokers Attending a Smoking Cessation Clinic in Taiwan: 3-Year Follow-Up Study

Studies that have examined gender differences in smoking cessation have produced mixed results. The purpose of the study was to examine whether there are gender differences in long-term smoking abstinence rates in smokers treated with nicotine patches at a smoking cessation clinic in Taiwan, where 39% of men and 5% of women smoke. This study included 1,065 smokers, comprising of 940 men and 125 women. Smokers were invited to attend the clinic every 1-2 weeks for a maximum of eight visits over 90 days, where they received prescriptions for nicotine patches, counseling, and educational materials. Participants were contacted by telephone at 1 and 3 years after the first visit and were asked whether they had smoked at all over the past 7 days. The results showed that women were significantly less likely than men to be abstinent at 1 year (adjusted odds ratio [aOR] = 0.64; 95% CI [confidence interval] = [0.41, 0.99]; p = .044) and 3 years (aOR = 0.44; 95% CI = [0.27, 0.74]; p = .02). More effective ways are needed to help female smokers quit in societies where smoking in women is rare and may be associated with social stigma.

What distinguishes successful from unsuccessful tobacco smoking cessation? Data from a study of young adults (TEMPO)

INTRODUCTION

Smoking prevalence rates among young people are high in many countries. Although attempts to quit smoking increasingly occur in young adulthood, many former smokers relapse. We compared individuals who successfully quit smoking from those who relapsed on socio-demographic, psychological and health factors.

METHODS

Data come from telephone interviews conducted in 2011 with participants of the TEMPO community-based study (ages 18-37 years, France). To study the likelihood of successful cessation vs. smoking relapse, we restricted the study sample to current or former smokers (n = 600) and conducted multinomial logistic regression analyses.

RESULTS

43% of participants were current smokers who never quit for an extended period and, 33% former smokers and 24% current smokers who relapsed after extended cessation. In multivariate analyses female sex, parental status and illegal drug use were associated with both successful and unsuccessful smoking cessation. Factors specifically associated with a low probability of smoking cessation were job strain and symptoms of hyperactivity/inattention, while occupational grade was associated with smoking relapse.

CONCLUSIONS

Work and family circumstances, co-occurring substance use and psychological difficulties may influence smoking cessation in young adults. These characteristics should be considered by individual and collective interventions aiming to help young smokers quit successfully.

Computer-tailored smoking cessation advice matched to reading ability: Perceptions of participants from the ESCAPE trial

OBJECTIVE

To explore perceptions of computer-tailored advice reports for smoking cessation matched to the recipient's reading level.

METHODS

Current cigarette smokers in the UK aged 18-65 who completed a Smoking Behavior Questionnaire (n=6911) were randomized to receive standard generic materials or standard materials plus computer-tailored reports adapted to the recipient's reading level. Smoking status and perception of the reports was assessed at a 6-month follow-up. 4677 participants were included in the analysis.

RESULTS

53.3% were categorized into the easy reading group (ERG). The relative benefit of the intervention for prolonged 3-month abstinence was more marked in the ERG (2.6%/1.9%, OR=1.50) than in the standard reading group (SRG) (4.0%/3.8%, OR=1.05), although the interaction was not statistically significant. Participants in the Intervention group perceived the standard materials more positively than did those in the Control group, and participants in the ERG perceived both the generic material and the tailored report more positively.

CONCLUSIONS

The easy reading version of this brief self-help intervention was better perceived than the standard version, and appeared to have a small, but promising effect in smokers with a lower literacy level.

PRACTICE IMPLICATIONS

An association between reading level and deprivation emphasizes the need to adapt smoking cessation materials to address the needs of smokers with lower literacy.

Gender differences in medication use and cigarette smoking cessation: results from the International Tobacco Control Four Country Survey

INTRODUCTION

There is conflicting evidence for gender differences in smoking cessation, and there has been little research on gender differences in smoking cessation medication (SCM) use and effectiveness. Using longitudinal data from the International Tobacco Control Four Country Surveys (ITC-4) conducted in the United Kingdom, the United States, Canada, and Australia, we examined gender differences in the incidence of quit attempts, reasons for quitting, use of SCMs, reasons for discontinuing use of SCMs, and rates of smoking cessation.

METHODS

Data were analyzed from adult smokers participating in the ITC-4, annual waves 2006-2011 (n = 7,825), as well as a subsample of smokers (n = 1,079) who made quit attempts within 2 months of survey. Adjusted modeling utilized generalized estimating equations.

RESULTS

There were no gender differences in the likelihood of desire to quit, plans to quit, or quit attempts between survey waves. Among quit attempters, women had 31% lower odds of successfully quitting (OR = 0.69; 95% CI = 0.51, 0.94). Stratified by medication use, quit success was lower among women who did not use any SCMs (OR = 0.59; 95% CI = 0.39, 0.90), and it was no different from men when medications were used (OR = 0.73; 95% CI = 0.46, 1.16). In particular, self-selected use of nicotine patch and varenicline contributed to successful quitting among women.

CONCLUSIONS

Women may have more difficulty quitting than men, and SCMs use may help attenuate this difference.

Associations between use of pharmacological aids in a smoking cessation attempt and subsequent quitting activity: a population study

BACKGROUND AND AIMS

Modelling the population impact and cost-effectiveness of smoking cessation aids is limited by lack of knowledge about how the use of aids changes across quit attempts. Here we test whether the quit method used in a previous attempt influences (i) future decisions to quit and/or (ii) treatment/s used during subsequent attempts.

DESIGN AND SETTING

Data came from the Smoking Toolkit Study, a United Kingdom national household survey.

PARTICIPANTS AND MEASURES

Smokers (n = 5489) who completed a baseline and 6-month follow-up questionnaire. Respondents were asked what treatment/s, grouped as: prescription medication/s [bupropion, varenicline or nicotine replacement therapy (NRT)], over-the-counter NRT or unaided that they had used in their most recent quit attempt (at baseline), and any use of treatment/s for a quit attempt in the last 3 months at follow-up.

RESULTS

Smokers who had tried to quit at baseline were more likely to report having tried to quit again prior to follow-up [all odds ratios ≥ 2.19 relative to no attempt at baseline, P < 0.001]. Smokers who tried to quit using pharmacological aids were more likely to try to quit again at follow-up (all ORs ≥ 2.19 relative to no attempt at baseline, P < 0.001). Smokers tended to re-try aids used in baseline attempts in future attempts (all ORs ≥ 1.48 relative to no attempt at baseline, P < 0.01).

CONCLUSIONS

Smokers who have tried to quit in the past year are more likely to try to quit again within 6 months regardless of whether they used a pharmacological aid, and they are more likely to re-try aids they had used previously.

Understanding smoking after acute illness: An application of the sentinel event method

The sentinel event theory provides a stepwise approach for building models to understand how negative events can spark health behaviour change. This study tested a preliminary model using the sentinel events method in a sample (N = 300) of smokers who sought care for acute cardiac symptoms. Patients completed measures on: smoking-related causal attribution, perceived severity of the acute illness event, illness-related fear and intentions to quit smoking. Patients were followed up one week after the health event and a seven-day timeline follow back was completed to determine abstinence from tobacco. Structural equation models were performed using average predictor scale scores at baseline, as well as three different time anchors for ratings of illness severity and illness-related fear. Quit intentions, actual illness severity and age were the consistent, positive and independent predictors of seven-day point prevalence abstinence. Additional research on the influences of perceptions and emotional reactions is warranted.

Overcoming limitations in previous research on exercise as a smoking cessation treatment: rationale and design of the "Quit for Health" trial

Aerobic exercise has been proposed as a stand-alone or adjunct smoking cessation treatment, but findings have been mixed. Laboratory studies have shown that individual exercise sessions lead to decreases in withdrawal symptoms and cigarette cravings, but findings are limited by lack of follow-up and artificial settings. On the other hand, smoking cessation treatment RCTs have generally failed to show positive effects of exercise on smoking cessation, but have been plagued by poor and/or unverified compliance with exercise programs. This paper describes the rationale and design for Quit for Health (QFH)--an RCT designed to determine the efficacy of aerobic exercise as an adjunct smoking cessation treatment among women. To overcome limitations of previous research, compliance with the exercise (and wellness contact control) program is incentivized and directly observed, and ecological momentary assessment is used to examine change over time in withdrawal symptoms and cigarette cravings in participants' natural environments.

Effectiveness of the gold standard programmes (GSP) for smoking cessation in pregnant and non-pregnant women

Background: Smoking is considered the most important preventable risk factor in relation to the development of complications during pregnancy and delivery. The aim of this study was to evaluate the effectiveness of an intensive 6-week gold standard programme (GSP) on pregnant women in real life. Methods: This was a prospective cohort study based on data from a national Danish registry on smoking cessation interventions. The study population included 10,682 women of a fertile age. The pregnancy status of the study population was identified using the National Patient Registry. Results: The response rate to follow up was 76%. The continuous abstinence rate for both pregnant and non-pregnant smokers was 24–32%. The following prognostic factors for continuous abstinence were identified: programme format (individual/group), older age, heavy smoking, compliance with the programme, health professional recommendation, and being a disadvantaged smoker. Conclusions: The GSP seems to be as effective among pregnant smokers as among non-pregnant smoking women. Due to the relatively high effect and clinical significance, the GSP would be an attractive element in smoking cessation intervention among pregnant women.