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Bada F, Mansfield ME, Okui L, Montebatsi M, DiClemente C, Tapera R, Ikgopoleng K, Mokonopi S, Magidson JF, Onukwugha E, Ndwapi N, Himelhoch S, Mbongwe B, Charurat M. Design and rationale of the Botswana Smoking Abstinence Reinforcement Trial: a protocol for a stepped-wedge cluster randomized trial. Implement Sci Commun 2024; 5:53. [PMID: 38720363 PMCID: PMC11077839 DOI: 10.1186/s43058-024-00588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND With expanded and sustained availability of HIV treatment resulting in substantial improvements in life expectancy, the need to address modifiable risk factors associated with leading causes of death among people living with HIV/AIDS (PLWH), such as tobacco smoking, has increased. Tobacco use is highly prevalent among PLWH, especially in southern Africa, where HIV is heavily concentrated, and many people who smoke would like to quit but are unable to do so without assistance. SBIRT (Screening, Brief Intervention and Referral to Treatment) is a well-established evidence-based approach successful at supporting smoking cessation in a variety of settings. Varenicline is efficacious in supporting smoking cessation. We intend to assess the effectiveness of SBIRT and varenicline on smoking cessation among PLWH in Botswana and the effectiveness of our implementation. METHODS BSMART (Botswana Smoking Abstinence Reinforcement Trial) is a stepped-wedge, cluster randomized, hybrid Type 2 effectiveness-implementation study guided by the RE-AIM framework, to evaluate the effectiveness and implementation of an SBIRT intervention consisting of the 5As compared to an enhanced standard of care. SBIRT will be delivered by trained lay health workers (LHWs), followed by referral to treatment with varenicline prescribed and monitored by trained nurse prescribers in a network of outpatient HIV care facilities. Seven hundred and fifty people living with HIV who smoke daily and have been receiving HIV care and treatment at one of 15 health facilities will be recruited if they are up to 18 years of age and willing to provide informed consent to participate in the study. DISCUSSION BSMART tests a scalable approach to achieve and sustain smoking abstinence implemented in a sustainable way. Integrating an evidence-based approach such as SBIRT, into an HIV care system presents an important opportunity to establish and evaluate a modifiable cancer prevention strategy in a middle-income country (MIC) setting where both LHW and non-physician clinicians are widely used. The findings, including the preliminary cost-effectiveness, will provide evidence to guide the Botswanan government and similar countries as they strive to provide affordable smoking cessation support at scale. CLINICAL TRIAL REGISTRATION NCT05694637 Registered on 7 December 2022 on clinicaltrials.gov, https://clinicaltrials.gov/search?locStr=Botswana&country=Botswana&cond=Smoking%20Cessation&intr=SBIRT.
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Affiliation(s)
- Florence Bada
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Megan E Mansfield
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lillian Okui
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Milton Montebatsi
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Carlo DiClemente
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Roy Tapera
- School of Public Health, University of Botswana, Gaborone, Botswana
- Anti-Tobacco Network, University of Botswana, Gaborone, Botswana
| | - Kaizer Ikgopoleng
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Selebaleng Mokonopi
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Jessica F Magidson
- Department of Psychology and the Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, Maryland, USA
| | - Eberechukwu Onukwugha
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Ndwapi Ndwapi
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Seth Himelhoch
- Department of Psychiatry, University of Kentucky School of Medicine, Lexington, KY, USA
| | - Bontle Mbongwe
- School of Public Health, University of Botswana, Gaborone, Botswana
- Anti-Tobacco Network, University of Botswana, Gaborone, Botswana
| | - Man Charurat
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Sadasivam RS, Nagawa CS, Wijesundara JG, Flahive J, Nguyen HL, Larkin C, Faro JM, Balakrishnan K, Ha DA, Nguyen CK, Vuong A, Phan PT, Pham QPL, Allison JJ, Houston TK. Peer Texting to Promote Quitline Use and Smoking Cessation Among Rural Participants in Vietnam: Randomized Clinical Trial. Int J Public Health 2024; 69:1606941. [PMID: 38651035 PMCID: PMC11033404 DOI: 10.3389/ijph.2024.1606941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/29/2024] [Indexed: 04/25/2024] Open
Abstract
Objectives: We tested an adapted version of an effective U.S.-based peer-texting intervention to promote Quitline use and smoking cessation among rural participants in Vietnam. Methods: We conducted a two-arm randomized trial with participants recruited at four rural community centers. The intervention included peer messages sent for six months that promoted Quitline use and smoking cessation. Additionally, biweekly two-way text messages assessed participants' interest in Quitline referral and current smoking status. Comparison participants received only the bi-weekly text message assessment of their current smoking status. At six months, we assessed Quitline use and smoking cessation. Smoking cessation was assessed using the 7-day point prevalence question and verified with a carbon monoxide breath monitor (<=6 ppm). Results: Among 750 participants, the intervention had higher Quitline verified use (18%, 95% CI 0.14, 0.22) than comparison (1%, 95% CI .2, 2, p < 0.0001). Carbon-monoxide-verified smoking cessation did not differ between the two groups. However, intervention (28.3%, 95% CI) and comparison (28.1%, 95% CI) participants had substantial rates of carbon monoxide cessation at 6 months (both 28%). Conclusion: Our study highlighted the promise of texting interventions to extend tobacco control efforts in Vietnam.
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Affiliation(s)
- Rajani S. Sadasivam
- University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Catherine S. Nagawa
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Jessica G. Wijesundara
- University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Julie Flahive
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Hoa L. Nguyen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Celine Larkin
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Jamie M. Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Kavitha Balakrishnan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Duc Anh Ha
- Ministry of Health (Vietnam), Hanoi, Vietnam
| | - Cuong Kieu Nguyen
- Institute of Population, Health and Development (PHAD), Hanoi, Vietnam
| | - Anh Vuong
- Institute of Population, Health and Development (PHAD), Hanoi, Vietnam
| | - Phuong Thu Phan
- Institute of Population, Health and Development (PHAD), Hanoi, Vietnam
| | | | - Jeroan J. Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Thomas Karr Houston
- School of Medicine, Wake Forest University, Winston-Salem, NC, United States
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Ricciardone MD, Baker L, Twesten J, Parascandola M. Portfolio analysis of global tobacco control research funding at the National Cancer Institute, 2000-2019. Tob Prev Cessat 2024; 10:TPC-10-13. [PMID: 38440159 PMCID: PMC10910547 DOI: 10.18332/tpc/184041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Research in low- and middle-income countries (LMICs), where the majority of global tobacco users reside, is critical to addressing the global tobacco epidemic. This analysis describes the global tobacco control research portfolio funded by the National Cancer Institute from fiscal years 2000 to 2019. METHODS We used the National Institutes of Health Query, View, Report database to identify extramural grants relevant to global tobacco control research. Abstracts were analyzed to describe grant characteristics, including topic areas, tobacco products, countries, and regions of focus. Bibliometric and co-authorship network analyses were performed for publications associated with relevant grants. RESULTS Of the 93 relevant grants with foreign (non-US) involvement, the majority (83.9%) supported research in upper and lower middle-income countries. The majority of grants (86.0%) focused on cigarettes, with a small subset of grants addressing smokeless tobacco, waterpipe use, or other non-cigarette products. Most grants focused on at least one of the six tobacco control policy measures in the World Health Organization MPOWER package; almost half (48.4%) focused on monitoring tobacco use and around one-third (32.3%) focused on offering tobacco cessation treatment, while other MPOWER measures received less attention in the research portfolio. While most of these grants, and the funding initiatives that supported them, emphasized research in low- and middle-income countries (LMICs), only 3 of 93 grants were awarded directly to LMIC-based institutions. CONCLUSIONS There is a critical need for research to develop and test strategies to adapt, implement, and scale up evidence-based interventions across diverse LMIC settings. This study identified gaps in research activity that should be addressed to strengthen global tobacco control research capacity.
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Affiliation(s)
| | - Laura Baker
- Strategix Management, LLC, Washington, DC 20036, USA
| | - Jenny Twesten
- The Bizzell Group, LLC, New Carrollton, MD 20785, USA
| | - Mark Parascandola
- Center for Global Health, National Cancer Institute, Bethesda, MD 20892, USA
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Wipfli H, Arinaitwe J, Goma F, Atuyambe L, Guwatudde D, Phiri MM, Rutebemberwa E, Wabwire-Mangen F, Zulu R, Zyambo C, Guy K, Kusolo R, Mukupa M, Musasizi E, Tucker JS. A phone-based tobacco use cessation program for people living with HIV in Uganda and Zambia: study protocol for a randomized controlled trial. Addict Sci Clin Pract 2024; 19:6. [PMID: 38243301 PMCID: PMC10797805 DOI: 10.1186/s13722-024-00438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Nicotine replacement therapy (NRT) and short messaging service (SMS)-based tobacco cessation interventions have demonstrated effectiveness in reducing tobacco use in many populations, but evidence is needed on which tailored treatments are most efficacious in meeting the complex medical and psychosocial factors confronting people living with HIV (PLWH) in sub-Saharan Africa (SSA). This paper describes the protocol of a study to test the efficacy of both NRT and a tailored SMS-based tobacco use cessation intervention among PLWH in Uganda and Zambia. METHODS In a randomized controlled trial, 800 adult PLWH who use tobacco will be recruited by health care professionals at HIV treatment centers where they are receiving care. Participants will be randomized to one of the four study arms: (1) standard of care [SOC; brief clinician advice to quit combined with HIV education and information aimed at encouraging HIV treatment adherence (with no mention of tobacco) delivered via text messages]; (2) SOC + 12 weeks of NRT; (3) SOC + 6 weeks of SMS text messages to support quitting tobacco use (SMS); or (4) SOC + NRT + SMS. Participants will receive a cell phone and solar panel with power bank for charging the phone. The main outcome is cessation of tobacco use by study participants verified by urinary cotinine (< 15 ng/mL) at 6 months post-enrollment. As a secondary tobacco use outcome, we will measure 7-day point-prevalence abstinence (7 consecutive days of no tobacco use) measured by self-report and biochemically-verified at 4 weeks, 8 weeks, and 3 months post enrollment. DISCUSSION Our study will provide insight into the efficacy, feasibility and applicability of delivering tobacco cessation interventions through health care professionals combined with tailored tobacco cessation SMS text messaging in two countries with different tobacco use patterns, policy environments, and health care resources and provide needed information to providers and policymakers looking for cost-effective tobacco cessation interventions. The previously tested SMS-platform to be used in our study is uniquely positioned to be scaled in low- and middle-income countries worldwide, in which case evidence of even modest success in reducing the prevalence of tobacco consumption among PLWH could confer enormous health and economic benefits. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05487807. Registered August 4, 2022, https://clinicaltrials.gov/ct2/show/record/NCT05487807.
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Affiliation(s)
- Heather Wipfli
- Keck School of Medicine, Department of Preventative Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90033, USA.
| | - Jim Arinaitwe
- School of Public Health, Makerere University, Centre for Tobacco Control in Africa, Kampala, Uganda
| | - Fastone Goma
- School of Medicine, University of Zambia, Centre For Primary Care Research, Lusaka, Zambia
| | - Lynn Atuyambe
- School of Public Health, Department of Community Health and Behavioural Sciences, Makerere University, Kampala, Uganda
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Masauso Moses Phiri
- School of Medicine, University of Zambia, Centre For Primary Care Research, Lusaka, Zambia
- School of Medicine, Department of Pathology and Microbiology, University of Zambia, Lusaka, Zambia
| | - Elizeus Rutebemberwa
- School of Public Health, Department of Health Policy, Makerere University, Planning, and Management, Kampala, Uganda
| | - Fred Wabwire-Mangen
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Richard Zulu
- School of Medicine, University of Zambia, Centre For Primary Care Research, Lusaka, Zambia
| | - Cosmas Zyambo
- School of Public Health, Department of Community and Family Medicine, University of Zambia, Lusaka, Zambia
| | - Kyra Guy
- Keck School of Medicine, Department of Preventative Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90033, USA
| | - Ronald Kusolo
- School of Public Health, Makerere University, Centre for Tobacco Control in Africa, Kampala, Uganda
| | - Musawa Mukupa
- School of Medicine, University of Zambia, Centre For Primary Care Research, Lusaka, Zambia
| | - Ezekiel Musasizi
- School of Public Health, Makerere University, Centre for Tobacco Control in Africa, Kampala, Uganda
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Lahoti S, Panda R, Prabhu RR, Das S, Patro SK, Nazareth I. Validation of Mobile Messages for an mHealth Intervention for Smokeless Tobacco Cessation in India. Asian Pac J Cancer Prev 2023; 24:4011-4015. [PMID: 38156832 PMCID: PMC10909114 DOI: 10.31557/apjcp.2023.24.12.4011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND With the growth in use of mobile messages for behaviour change, the need to incorporate personal needs and cultural characteristics of target users has been promoted. The study aimed to describe the findings of content validation of mobile messages designed to promote smokeless tobacco cessation in primary care. METHODS This study used a concurrent mixed-method approach with 13 patients who were tobacco users at urban primary care clinics. The clarity and appeal of 32 messages were rated on a Likert scale from 1 to 10. A mean clarity and appeal score per message was generated. A 5-item discussion guide was used for in-depth interviews and data was analysed using framework analysis. RESULTS Participants found the content of the messages useful, and preferred shorter and audio formatted messages. The clarity scores for the messages ranged from 7.9 to 9.4 with an average score of 8.7 (SD 0.5). The appeal scores ranged from 7.3 to 9.2, with an average score of 8.5 (SD 0.6). CONCLUSIONS Twenty-six from a total of 32 messages were found appropriate and finalised for use. This methodology can be used when developing contextually relevant mobile message interventions in other low resource settings.
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Affiliation(s)
- Supriya Lahoti
- Consultant, Extension for Community Healthcare Outcomes (ECHO) India, Okhla Phase III, New Delhi, India.
| | - Rajmohan Panda
- Public Health Foundation of India (PHFI), New Delhi, India.
| | - Rajath R Prabhu
- Medical Content Writer, HexaHealth, Gurugram, Haryana, India.
| | - Sangeeta Das
- Department of Community Medicine, SJMCH, Puri, India.
| | - Sithun Kumar Patro
- Department of Community Medicine, MKCG Medical College, Ganjam, Odisha, India.
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London, UK.
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Pahwa V, Pimple SA, Bhattacharjee A, Kuberkar D, Mishra GA, Chaturvedi P. Behavioural interventions for tobacco cessation in India: A systematic review and meta-analysis. J Family Med Prim Care 2023; 12:2542-2551. [PMID: 38186806 PMCID: PMC10771179 DOI: 10.4103/jfmpc.jfmpc_1017_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 01/09/2024] Open
Abstract
Tobacco consumption is an area of public health concern in India. One of the unmet needs of many low-resource countries is to provide cost-effective tobacco cessation interventions for reducing tobacco-related mortality. This article reviews studies on non-pharmacological interventions for tobacco cessation in India. A systematic review by PICO (population, intervention, comparison, outcome) of behavioural intervention-based tobacco cessation studies that met the inclusion criteria, with a minimum 1-month follow-up, reporting outcomes in terms of frequencies or percentages published between 2010 and 2020 was performed. Following the review stages, 16 studies comprising 9,613 participants were included in the review. A pooled estimate was derived using both fixed-effects and random-effects models. The intervention showed good overall efficacy for any tobacco user (relative risk [RR] = 1.73 [95% confidence interval [CI]: 1.58-1.90) (fixed-effect model)] and (RR = 2.02 [95% CI: 1.64-2.48] [random-effects model]). Behavioural intervention studies targeted towards only smokers (RR of 1.81 [95% CI: 1.55-2.11] and 1.96 [95% CI: 1.52-2.53]) and combined smoking and smokeless tobacco users (RR of 1.69 [95% CI: 1.50-1.90] and 2.12 [95% CI: 1.49-3.01]) were equally efficacious. The review provides the effectiveness of behavioural interventions in quitting tobacco among users of both smoking and smokeless forms of tobacco. The review findings are of particular significance to inform health policy decisions on the integration of cost-effective brief behavioural intervention into existing health care services in resource-constrained countries.
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Affiliation(s)
- Vandita Pahwa
- Department of Preventive Oncology, Homi Bhabha Cancer Hospital and Research Center, New Chandigarh, Punjab, India
| | - Sharmila A. Pimple
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deepali Kuberkar
- Department of Library Science, Digital Library, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Gauravi A. Mishra
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head Neck Surgery, Deputy Director, Centre for Cancer Epidemiology (CCE), Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
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Gjorgjievski D, Stavrikj K, Jordan R, Adab P, Stanoevski G, Stamenova A, Krstevska E, Simonovska S, Trpcheski F, Adams R, Easter C, Rai K, Cheng KK, Chi C, Cooper BG, Correia-de-Sousa J, Dickens AP, Enocson A, Gale N, Jolly K, Jowett S, Maglakelidze M, Maghlakelidze T, Martins S, Sitch A, Stelmach R, Turner A, Williams S, Farley A. Randomised controlled trial testing effectiveness of feedback about lung age or exhaled CO combined with very brief advice for smoking cessation compared to very brief advice alone in North Macedonia: findings from the Breathe Well group. BMC Public Health 2023; 23:1887. [PMID: 37773124 PMCID: PMC10541684 DOI: 10.1186/s12889-023-16644-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 08/29/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION In 2019, smoking prevalence in North Macedonia was one of the world's highest at around 46% in adults. However, access to smoking cessation treatment is limited and no co-ordinated smoking cessation programmes are provided in primary care. METHODS We conducted a three parallel-armed randomised controlled trial (n = 1368) to investigate effectiveness and cost-effectiveness of lung age (LA) or exhaled carbon monoxide (CO) feedback combined with very brief advice (VBA) to prompt smoking cessation compared with VBA alone, delivered by GPs in primary care in North Macedonia. All participants who decided to attempt to quit smoking were advised about accessing smoking cessation medications and were also offered behavioural support as part of the "ACT" component of VBA. Participants were aged ≥ 35 years, smoked ≥ 10 cigarettes per day, were recruited from 31 GP practices regardless of motivation to quit and were randomised (1:1:1) using a sequence generated before the start of recruitment. The primary outcome was biochemically validated 7-day point prevalence abstinence at 4 weeks (wks). Participants and GPs were not blinded to allocation after randomisation, however outcome assessors were blind to treatment allocation. RESULTS There was no evidence of a difference in biochemically confirmed quitting between intervention and control at 4wks (VBA + LA RR 0.90 (97.5%CI: 0.35, 2.27); VBA + CO RR 1.04 (97.5%CI: 0.44, 2.44)), however the absolute number of quitters was small (VBA + LA 1.6%, VBA + CO 1.8%, VBA 1.8%). A similar lack of effect was observed at 12 and 26wks, apart from in the VBA + LA arm where the point estimate was significant but the confidence intervals were very wide. In both treatment arms, a larger proportion reported a reduction in cigarettes smoked per day at 4wks (VBA + LA 1.30 (1.10, 1.54); VBA + CO 1.23 (1.03, 1.49)) compared with VBA. The point estimates indicated a similar direction of effect at 12wks and 26wks, but differences were not statistically significant. Quantitative process measures indicated high fidelity to the intervention delivery protocols, but low uptake of behavioural and pharmacological support. VBA was the dominant intervention in the health economic analyses. CONCLUSION Overall, there was no evidence that adding LA or CO to VBA increased quit rates. However, a small effect cannot be ruled out as the proportion quitting was low and therefore estimates were imprecise. There was some evidence that participants in the intervention arms were more likely to reduce the amount smoked, at least in the short term. More research is needed to find effective ways to support quitting in settings like North Macedonia where a strong smoking culture persists. TRIAL REGISTRATION The trial was registered at http://www.isrctn.com (ISRCTN54228638) on the 07/09/2018.
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Affiliation(s)
- Dragan Gjorgjievski
- Centre for Family Medicine, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Katarina Stavrikj
- Centre for Family Medicine, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Rachel Jordan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Gjorgji Stanoevski
- Centre for Family Medicine, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Aleksandra Stamenova
- Centre for Family Medicine, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Emilija Krstevska
- Centre for Family Medicine, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Sara Simonovska
- Centre for Family Medicine, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Fillip Trpcheski
- Centre for Family Medicine, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Rachel Adams
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Christina Easter
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Kiran Rai
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Chunhua Chi
- Department of General Practice, Peking University First Hospital, Beijing, China
| | | | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Andrew P Dickens
- Observational and Pragmatic research Institute, Midview City, Singapore
| | - Alexandra Enocson
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Nicola Gale
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Sue Jowett
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Mariam Maglakelidze
- Petre Shotadze Tbilisi Medical Academy, 51/2 Ketevan Dedofali Ave, Tbilisi, 0144, Georgia
| | - Tamaz Maghlakelidze
- Ivane Javakhishvili Tbilisi State University, 1 Ilia Chavchavadze Avenue, Tbilisi, 0179, Georgia
| | - Sonia Martins
- Family Medicine, ABC Medical School, Sao Paolo, Brazil
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Rafael Stelmach
- Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Siân Williams
- International Primary Care Respiratory Group, 19 Armour Mews, Larbert, FK5 4FF, Scotland
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Krishnamoorthy Y, Elangovan V, Rajaa S. Non-pharmacological Interventions for Tobacco Cessation in India: A Systematic Review and Network Meta-analysis. Nicotine Tob Res 2023; 25:1701-1708. [PMID: 37195879 DOI: 10.1093/ntr/ntad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/17/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Non-pharmacological management of tobacco cessation has been reported to yield a high level of abstinence from tobacco usage. However, it is unclear which type of non-pharmacological intervention to be adopted in national tobacco control program. Hence, we undertook this review to identify the best non-pharmacological tobacco cessation therapies for tobacco cessation. AIMS AND METHODS Systematic literature search was performed in EMBASE, SCOPUS, PubMed Central, CENTRAL, MEDLINE, Google Scholar, ScienceDirect, and Clinicaltrials.gov from 1964 until September 2022. Randomized controlled trials assessing the effectiveness of non-pharmacological intervention for tobacco cessation in India were eligible for inclusion. Comparative intervention effect estimates obtained from network meta-analyses were represented as pooled odds ratio (OR) with 95% confidence interval (CI). RESULTS 21 studies were eligible for the analysis. More than half of the studies had high risk of bias. E-Health intervention had the highest OR (pooled OR = 9.90; 95% CI: 2.01 to 48.86) in terms of tobacco cessation rate followed by group counseling (pooled OR = 3.61; 95% CI: 1.48 to 8.78) and individual counseling (pooled OR = 3.43; 95% CI: 1.43 to 8.25). Brief advice or self-help intervention or comparison between each of these interventions against each other (both direct and indirect network) did not yield any significant results. CONCLUSIONS E-Health intervention was the best intervention followed by group intervention and individual face-to-face counseling intervention for tobacco cessation in India. Nonetheless, more high-quality large-scale RCTs either individual or by combining the e-Health, individual, or group counseling interventions are required to provide conclusive evidence and subsequent adoption into the national health programs in India. IMPLICATIONS This study would aid the policymakers, clinicians, and public health researchers in choosing the right tobacco cessation therapy to be offered across various levels of the healthcare delivery system, including major health facilities providing drug therapy (ie, concurrently with pharmacological treatment for tobacco cessation) in India. The study findings can be adopted by the national tobacco control program to decide the appropriate intervention package and identify the areas of focus to perform tobacco-related research in the country.
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Affiliation(s)
| | - Venmathi Elangovan
- Department of Community Medicine, ESIC Medical College and Hospital, Chennai, India
| | - Sathish Rajaa
- Department of Community Medicine, ESIC Medical College and Hospital, Chennai, India
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Iyahen EO, Omoruyi OO, Rowa-Dewar N, Dobbie F. Exploring the barriers and facilitators to the uptake of smoking cessation services for people in treatment or recovery from problematic drug or alcohol use: A qualitative systematic review. PLoS One 2023; 18:e0288409. [PMID: 37440505 DOI: 10.1371/journal.pone.0288409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Smoking prevalence and the associated poor health and mortality is significantly higher among people with/recovering from problematic drug or alcohol (PDA) use in comparison with the general population. Evidence from existing systematic reviews shows smoking cessation enhances rather than compromises long-term abstinence from alcohol or drug use. However, these systematic reviews lack important contextual detail around the reasons why uptake of, and successful engagement with existing stop smoking services remains low for people in treatment or recovery from PDA use. This systematic review explores qualitative data on the barriers and facilitators to the uptake of smoking cessation services for people in treatment or recovery from PDA use. This key objective addresses the limited inclusion of qualitative studies in previous systematic reviews on this issue. METHODS A qualitative systematic review was conducted with searches across four electronic databases (PubMed, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature [CINAHL]). All studies that had a qualitative component about free smoking cessation/reduction programmes for people in treatment or recovery from PDA use were included. Studies that examined electronic smoking or services that required a fee were excluded. Study quality was assessed using National Institute for Health and Care Excellence checklist. Qualitative synthesis involved inductive thematic analysis. (PROSPERO Registration number: CRD42022298521). RESULTS 8809 potentially eligible articles were identified, 72 full texts were screened and ten articles were included for full review. Barriers to uptake and engagement with existing stop smoking services centered on three key themes: perception of public health importance, programme structure, and intervention elements. Facilitators included supportive treatment environment and optimization of support/staff resources for smoking cessation service delivery. CONCLUSION Recommendations included influencing a change in the way people perceive the importance of smoking cessation activities during PDA use treatment or recovery. There was also some emphasis on the need to create the right environment for sustained adherence to treatment or recovery plans, and deliver the interventions within the health system as comprehensive care. The limited qualitative evidence on community-based and outpatient services highlights a research gap.
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Affiliation(s)
| | | | - Neneh Rowa-Dewar
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Fiona Dobbie
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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10
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Mohd Noordin Z, Neoh CF, Ibrahim@ Ghazali NH, Karuppannan M. "A person who do not smoke will not understand a person who smokes and trying to quit…" Insights From Quit Smoking Clinics' Defaulters: A Qualitative Study. J Patient Exp 2023; 10:23743735231184690. [PMID: 37424538 PMCID: PMC10328151 DOI: 10.1177/23743735231184690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
This study explored the factors contributing to discontinuation of people who smoke (PWS) from quit smoking clinic prior to achieving 6-month abstinence. Fifteen active PWS were interviewed via telephone and face-to-face. Interviews were audio-recorded, transcribed and analysed using thematic analysis. At individual level, low intrinsic motivation including unreadiness to quit, low self-efficacy and ambivalence on smoking cessation were barriers to attain successful cessation. Influence of extrinsic factors such as work-related factors, social interaction and ill-health burden lead to poor commitment with QSC. At the clinic level, healthcare professional's competency, personal attributes, pharmacotherapy's efficacy, safety and availability were important components that may affect a participant's effort to quit. Working commitment was highlighted as the primary barrier for a successful cessation. Hence, effective intervention and collaborative effort between healthcare facilities and employers are essential to optimise cessation adherence among employees who smoke which subsequently will enhance their abstinence rates.
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Affiliation(s)
- Zakiah Mohd Noordin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti Teknologi MARA Selangor Branch, Puncak Alam Campus, Selangor, Malaysia
- Cardiology Therapeutics Research Group, Faculty of Pharmacy, Universiti Teknologi MARA Selangor Branch, Puncak Alam Campus, Selangor, Malaysia
| | - Chin Fen Neoh
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | | | - Mahmathi Karuppannan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti Teknologi MARA Selangor Branch, Puncak Alam Campus, Selangor, Malaysia
- Cardiology Therapeutics Research Group, Faculty of Pharmacy, Universiti Teknologi MARA Selangor Branch, Puncak Alam Campus, Selangor, Malaysia
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Gawde NC, Quazi Syed Z. Determinants of Quit Attempts and Short-Term Abstinence among Smokers in India: Global Adult Tobacco Survey, 2016-17. Asian Pac J Cancer Prev 2023; 24:2279-2288. [PMID: 37505757 PMCID: PMC10676471 DOI: 10.31557/apjcp.2023.24.7.2279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE The objective was to study the determinants of quit attempts and abstinence among smokers in India using nationally representative data from the Global Adult Tobacco Survey (GATS-2). METHODS Data from GATS-India, (2016-17) was analysed. Key outcome variables included quitting attempts in the previous 12 months among smokers and duration of abstinence among those who attempted quitting. The receipt of messages through mass media, warning labels and quit advice by doctors or healthcare providers were key exposure variables for both outcomes. The use of cessation methods was an exposure variable for abstinence. Logistic regression analyses were employed to identify determinants of quit attempt and survival analysis for the duration of abstinence. RESULT The adjusted analyses showed that those who received quit advice from doctors or healthcare providers had higher odds (2.11; CI 1.88-2.37) of quit attempts. Exposure to anti-smoking messages through media and warning labels was associated with higher quit attempt odds of 1.53 (1.33-1.77) and 1.63 (1.38-1.92), respectively, when the anti-smoking messages made the smokers think about quitting. The use of counselling as a cessation method had a lower risk (Hazard Ratio 0.80; 0.69-0.93) of relapse compared to the non-use of cessation aids. The use of counselling and modern pharmacotherapy also had a lower risk of relapse (Hazard Ratio 0.77; 0.59-0.99). However, only 6.0% had used counselling, and another 2.0% had used a combination of modern pharmacotherapy and counselling as cessation aids. Addiction to tobacco and higher consumption of smoked sticks were negatively associated with both outcomes. CONCLUSION Quit advice by healthcare providers is associated with a higher likelihood of quit attempts. Counselling can help increase the period of abstinence in pragmatic settings, and there is a need to improve the access of smokers to counselling services.
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Affiliation(s)
- Nilesh C Gawde
- Centre for Public Health, School of Health Systems Studies, Tata Institute of Social Sciences, Deonar, Mumbai 400088, Maharashtra, India.
| | - Zahiruddin Quazi Syed
- Department of Community Medicine and Director (Research and Development), Datta Meghe Institute of Medical Sciences (DMIMS), Wardha 422001, Maharashtra, India.
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Fonseca HAR, Izar MCO, Drager LF, Pinto IM, Saraiva JFK, Ferreira JFM, Avezum Á, Fonseca FA, Berwanger O. Primary Prevention of Cardiovascular Disease at Community Clinics in the State of Sao Paulo, Brazil: Results from the Epidemiological Information Study of Communities. Glob Heart 2023; 18:24. [PMID: 37153847 PMCID: PMC10162207 DOI: 10.5334/gh.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/12/2023] [Indexed: 05/10/2023] Open
Abstract
Background Primary prevention of cardiovascular disease (CVD) remains a major challenge, especially in communities of low- and middle-income countries with poor medical assistance influenced by distinct local, financial, infrastructural, and resource-related factors. Objective This a community-based study aimed to determine the proportion and prevalence of uncontrolled cardiovascular risk factors (CRF) in Brazilian communities. Methods The EPICO study was an observational, cross-sectional, and community clinic-based study. Subjects were living in Brazilian communities and were of both sexes and ≥18 years old, without a history of a stroke or myocardial infarction but presenting at least one of the following cardiovascular risk factors: hypertension, diabetes mellitus and hypercholesterolemia. The study was carried out in Brazil, including 322 basic health units (BHU) in 32 cities. Results A total of 7,724 subjects with at least one CRF were evaluated, and one clinical visit was performed. Mean age was 59.2 years-old (53.7% were >60 years old). A total of 66.7% were women. Of the total, 96.2% had hypertension, 78.8% had diabetes mellitus type II, 71.1% had dyslipidemia, and 76.6% of patients were overweight/obese. Controlled hypertension (defined by <130/80 mmHg or <140/90 mmHg) was observed in 34.9% and 55.5% patients among respective criteria, the rates of controlled blood glucose in patients taking antidiabetic medications was 29.5%, and among those with documented dyslipidemia who received any lipid-lowering medication, only 13.9% had LDL-c on target. For patients presenting three CRF less than 1.9% had LDL-c < 100 mg/dL once their BP and blood glucose were on target. High education level as associated with blood pressure (BP) target of less than 130 / 80mm Hg. The glucose and LDL-c levels on target were associated with the presence of hypertension and diabetes mellitus. Conclusion In Brazilian community clinics, regarding most patients in primary prevention, the CRF such as BP, blood glucose, and lipid levels are poorly controlled, with a majority of patients not achieving guidelines/recommendations.
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Affiliation(s)
- Henrique Andrade R. Fonseca
- Research Center, Cardiology Society of the State of São Paulo –SOCESP, São Paulo, Brazil
- Hospital Albert Einstein, São Paulo, Brazil
- Cardiology Division, Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria Cristina O. Izar
- Research Center, Cardiology Society of the State of São Paulo –SOCESP, São Paulo, Brazil
- Cardiology Division, Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luciano F. Drager
- Research Center, Cardiology Society of the State of São Paulo –SOCESP, São Paulo, Brazil
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
- Centro de Cardiologia, Hospital Sírio Libanês, Brazil
| | - Ibraim M. Pinto
- Research Center, Cardiology Society of the State of São Paulo –SOCESP, São Paulo, Brazil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - José Francisco K. Saraiva
- Research Center, Cardiology Society of the State of São Paulo –SOCESP, São Paulo, Brazil
- Pontifícia Universidade Católica de Campinas, Campinas, Brazil
| | - João Fernando Monteiro Ferreira
- Research Center, Cardiology Society of the State of São Paulo –SOCESP, São Paulo, Brazil
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Álvaro Avezum
- Research Center, Cardiology Society of the State of São Paulo –SOCESP, São Paulo, Brazil
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Francisco Antonio Fonseca
- Research Center, Cardiology Society of the State of São Paulo –SOCESP, São Paulo, Brazil
- Cardiology Division, Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Otávio Berwanger
- Research Center, Cardiology Society of the State of São Paulo –SOCESP, São Paulo, Brazil
- Hospital Albert Einstein, São Paulo, Brazil
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13
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Mbulo L, Palipudi K, Smith T, Owusu D, Williams F, Dean AK, Mamudu HM. Secondhand Smoke Exposure Inside the Home Among Adults in Eight Countries in Sub-Saharan Africa: Global Adult Tobacco Survey, 2012-2018. Nicotine Tob Res 2023; 25:828-837. [PMID: 36272102 PMCID: PMC10032190 DOI: 10.1093/ntr/ntac247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 10/06/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Secondhand tobacco smoke (SHS) exposure causes diseases and death in adults and children. Evidence indicates that most SHS exposures occur at home and in the workplace. Therefore, home is a major place where adults and children can be effectively protected from SHS. This study examined the magnitude of SHS exposure at home and associated factors in eight sub-Saharan African countries. AIMS AND METHODS We analyzed 2012-2018 Global Adult Tobacco Survey data for Botswana, Cameroon, Ethiopia, Kenya, Nigeria, Senegal, Tanzania, and Uganda. We computed prevalence estimates of self-reported monthly SHS exposure at home reported as anyone smoking inside their home daily, weekly, or monthly. We calculated SHS exposure at home prevalence and applied multivariable logistic regression models to identify related factors. RESULTS Overall median prevalence of SHS exposure at home was 13.8% in the eight countries; ranging from 6.6% (95% CI: 5.7%, 7.6%) in Nigeria to 21.6% (95% CI: 19.4%, 24.0%) in Senegal. In multivariable analysis across the countries, SHS exposure at home was associated with living with a smoker, ranging from an adjusted odds ratio (AOR) of 4.6 (95% CI: 3.6, 5.8) in Botswana to 27.6 (95% CI: 20.1, 37.8) in Nigeria. SHS exposure at home was significantly associated with lower education attainment (Kenya and Ethiopia), and lower wealth index (Uganda, Senegal, and Botswana). CONCLUSIONS SHS exposure in homes was associated with the presence of a smoker in the home and lower socioeconomic status.
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Affiliation(s)
- Lazarous Mbulo
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Krishna Palipudi
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tenecia Smith
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel Owusu
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Anna K Dean
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Noninfectious Diseases Program, CDC Foundation, Atlanta, GA, USA
| | - Hadii M Mamudu
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
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Rodríguez-Bolaños R, Ramírez-Palacios P, Bolaños A, Lara D, Millan G, Gallegos-Carrillo K, Flores YN, Mejia RM, Cupertino AP, Cartujano-Barrera F. Decídetexto México: Recruitment and baseline characteristics of Mexican individuals who smoke in a cessation study. Tob Use Insights 2023; 16:1179173X231157378. [PMID: 37425216 PMCID: PMC10326465 DOI: 10.1177/1179173x231157378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
The objective of this study was to evaluate the effectiveness of digital and traditional methods and strategies in the recruitment of Mexican individuals who smoke into a cessation study. Recruitment method refers in general to either digital or traditional recruitment. Recruitment strategies refer to the particular recruitment type utilized within each recruitment method. Traditional recruitment strategies included radio interviews, word of mouth, newspaper advertisement, posters/banners placed in primary healthcare clinics, and medical referrals. Digital recruitment strategies involved emails and study advertisements through social media (i.e., Facebook, Instagram and Twitter) and website. In a 4-month period, 100 Mexican individuals who smoke were successfully enrolled into a smoking cessation study. The majority of participants were enrolled via traditional recruitment strategies (86%) compared to the digital recruitment strategies (14%). Individuals screened in the digital method were more likely to be eligible to participate in the study, compared to the traditional method. Similarly, in comparison to the traditional method, individuals in the digital method were more likely to enroll in the study. However, these differences were not statistically significant. Both traditional and digital strategies made important contributions to the overall recruitment effort.
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Affiliation(s)
| | - Paula Ramírez-Palacios
- Unidad de Investigación
Epidemiológica y en Servicios de Salud Delegación Morelos, Instituto Mexicano del Seguro
Social, Cuernavaca, Mexico
| | - Alejandra Bolaños
- Departamento de Investigación Sobre
Tabaco, Instituto Nacional de Salud
Pública, Cuernavaca, Mexico
| | - Daimarelys Lara
- Department of Public Health
Sciences, University of Rochester Medical
Center, Rochester, NY, USA
| | - Gabriel Millan
- Departamento de Investigación Sobre
Tabaco, Instituto Nacional de Salud
Pública, Cuernavaca, Mexico
| | - Katia Gallegos-Carrillo
- Unidad de Investigación
Epidemiológica y en Servicios de Salud Delegación Morelos, Instituto Mexicano del Seguro
Social, Cuernavaca, Mexico
| | - Yvonne N Flores
- Unidad de Investigación
Epidemiológica y en Servicios de Salud Delegación Morelos, Instituto Mexicano del Seguro
Social, Cuernavaca, Mexico
| | - Raúl M Mejia
- Departamento de Medicina
Ambulatoria, Universidad de Buenos
Aires, Buenos Aires, Argentina
| | - Ana Paula Cupertino
- Department of Public Health
Sciences, University of Rochester Medical
Center, Rochester, NY, USA
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15
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Allen MS, Tostes RC. Cigarette smoking and erectile dysfunction: an updated review with a focus on pathophysiology, e-cigarettes, and smoking cessation. Sex Med Rev 2023. [DOI: 10.1093/sxmrev/qeac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Abstract
Introduction
Cigarette smoking has major health implications and causes substantial damage to all organ systems. Approximately one-third of men are active smokers worldwide, and most men are unaware that cigarette smoking can contribute to erectile dysfunction (ED).
Objectives
This article aims to provide a comprehensive overview of research conducted on cigarette smoking and ED, with a particular focus on pathophysiology, electronic cigarettes (e-cigarettes), and smoking cessation.
Methods
A manual literature search was conducted on all research conducted on cigarette smoking and ED up to October 2022.
Results
Substantial evidence is now available showing that past and current cigarette smoking has dose-dependent associations with ED in studies controlling for age and important health comorbidities. Cigarette smoke contains nicotine, carbon monoxide, oxidant chemicals, and metals that can damage the endothelium and disrupt erectile processes. For current smokers, smoking abstinence can strengthen the endothelium and reverse diminished erectile function. The effect of e-cigarettes on endothelial damage and ED remains largely untested. E-cigarettes expose users to fine and ultrafine particles and toxins that can increase risk of cardiovascular injury, but these acute effects appear less potent than conventional cigarettes (long-term cardiovascular effects are still unknown). E-cigarettes are therefore likely to have less harmful effects on ED than conventional cigarettes.
Conclusions
Smoking cessation programs that focus on nicotine replacement therapy (transdermal patches, gum, or inhalers), behavioral counseling, social support, and education programs can be effective approaches to ED treatment in active smokers. Temporarily transferring from regular cigarettes to e-cigarettes—which transmit some of the same carcinogens as conventional cigarettes and are likely to have some long-term cardiovascular effects that disrupt erectile function—might also be useful for long-term smoking cessation and treatment of ED.
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Affiliation(s)
- Mark S Allen
- Department of Psychology and Therapeutic Studies , Leeds Trinity University, Leeds, LS18 5HD, UK
| | - Rita C Tostes
- Department of Pharmacology, University of São Paulo , São Paulo, Brazil
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Shankar A, Parascandola M, Sakthivel P, Kaur J, Saini D, Jayaraj NP. Advancing Tobacco Cessation in LMICs. Curr Oncol 2022; 29:9117-9124. [PMID: 36547127 PMCID: PMC9777415 DOI: 10.3390/curroncol29120713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/08/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Tobacco kills more than 8 million people worldwide every year. Over 80% of the world's 1.3 billion tobacco users live in low- and middle-income countries (LMICs), where the future burden is projected to grow. At the same time, progress in tobacco control has not advanced as far as in many LMICs. In particular, the implementation of tobacco-cessation programs and interventions remains limited. The bulk of the evidence for tobacco-cessation interventions comes from high-income countries and may not reflect the context in LMICs, particularly as resources and training for tobacco cessation are limited. This paper summarizes the current evidence for tobacco-cessation interventions in LMICs and highlights some key challenges and research gaps. Overall, there is a need to build capacity for locally relevant research and implementation science to support tailored cessation interventions and strategies for LMICs.
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Affiliation(s)
- Abhishek Shankar
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna 801507, India
- Correspondence:
| | - Mark Parascandola
- Research and Training Branch, Center for Global Health, National Cancer Institute, Bethesda, MD 20892, USA
| | - Pirabu Sakthivel
- Department of ENT & Head-Neck Surgery, KMCH Institute of Health Sciences and Research, Coimbatore 641014, India
| | - Jagdish Kaur
- Department of Healthier Populations and Non-Communicable Diseases (NCDs), WHO Regional Office for South-East Asia, New Delhi 110011, India
| | - Deepak Saini
- Materia Medica Department, Lal Bahadur Shastri Homoeopathic Medical College and Hospital, Prayagraj 211013, India
| | - Naveen Prabhu Jayaraj
- Department of Community Medicine, Karpagam Faculty of Medical Sciences and Research, Coimbatore 641032, India
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Ramanadhan S, Xuan Z, Choi J, Mahtani SL, Minsky S, Gupte H, Mandal G, Jagiasi D, Viswanath K. Associations between sociodemographic factors and receiving "ask and advise" services from healthcare providers in India: analysis of the national GATS-2 dataset. BMC Public Health 2022; 22:2115. [PMID: 36401241 PMCID: PMC9673333 DOI: 10.1186/s12889-022-14538-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
India is home to about 12% of the world's tobacco users, with about 1.35 million tobacco-related deaths each year. The morbidity and mortality rates are socially patterned based on gender, rural vs. urban residence, education, and other factors. Following the World Health Organization's guidance, it is critical to offer tobacco users support for cessation as a complement to policy and environmental changes. Such guidance is typically unavailable in low-resource systems, despite the potential for population-level impact. Additionally, service delivery for tobacco control tends to be patterned by sociodemographic factors. To understand current activity in this area, we assessed the percentage of daily tobacco users being asked about tobacco use and advised to quit by a healthcare provider. We also examined social patterning of receipt of services (related to by rural vs. urban residence, age, gender, education, caste, and wealth).
Methods
We analyzed cross-sectional data from India's 2016-2017 Global Adult Tobacco Survey (GATS-2), a nationally representative survey. Among 74,037 respondents, about 25% were daily users of smoked and/or smokeless tobacco. We examined rates of being asked and advised about tobacco use overall and based on rural vs. urban residence, age, gender, education, caste, and wealth. We also conducted multivariate logistic regression to assess the association of demographic and socioeconomic conditions with participants' receipt of “ask and advise” services.
Results
Nationally, among daily tobacco users, we found low rates of individuals reporting being asked about tobacco use or advised to quit by a healthcare provider (22% and 19%, respectively). Being asked and advised about tobacco use was patterned by age, gender, education, caste, and wealth in our final regression model.
Conclusions
This study offers a helpful starting point in identifying opportunities to address a critical service delivery gap in India. Given the existing burden on the public health and health systems, scale-up will require innovative, resource-appropriate solutions. The findings also point to the need to center equity in the design and scale-up of tobacco cessation supports so that marginalized and underserved groups will have equitable access to these critical services.
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Znyk M, Wężyk-Caba I, Kaleta D. The Frequency of Tobacco Smoking and E-Cigarettes Use among Primary Health Care Patients-The Association between Anti-Tobacco Interventions and Smoking in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11584. [PMID: 36141847 PMCID: PMC9517004 DOI: 10.3390/ijerph191811584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study was to assess the prevalence of smoking and e-cigarette use among primary care patients during the COVID-19 pandemic and to assess the frequency of minimal anti-tobacco interventions by family doctors. A cross-sectional study was conducted from January 2020 to December 2021 encompassing 896 patients over 18 years of age who used primary health care in the city of Lodz, Poland. In total, 21.2% of the respondents were smokers, 11.6% were e-cigarette users, and 7.3% dual users. In addition, 68.4% of smokers had been asked about smoking, while 62.9% of non-smokers and 33.7% of smokers were advised to quit smoking; furthermore, 71.1% of e-cigarette users and 72.3% of dual users were asked about tobacco use, and 17.3% and 21.5%, respectively, had been advised to quit smoking. Multivariate logistic regression analysis found men and alcohol users to receive more minimal anti-tobacco advice than women and non-alcohol users (OR = 1.46; p < 0.05 and OR = 1.45; p < 0.05), socio-demographic and health correlates did not increase the chances of obtaining minimal anti-tobacco interventions among smokers. People with a medium level of education had a higher chance of receiving minimal anti-tobacco intervention from their family doctor when using e-cigarettes and when they were dual users (OR = 2.06; p < 0.05 and OR = 2.51; p < 0.05). Smokers were less likely to receive minimal anti-tobacco interventions than reported in previous studies. Measures should be implemented to increase the minimum interventions provided by GPs in their daily work among all patients, not only those who use tobacco. Non-smokers should be encouraged to abstain.
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Jiang X, Jackson LJ, Syed MA, Avşar TS, Abdali Z. Economic evaluations of tobacco control interventions in low- and middle-income countries: a systematic review. Addiction 2022; 117:2374-2392. [PMID: 35257422 DOI: 10.1111/add.15821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Tobacco consumption and its associated adverse outcomes remain major public health issues, particularly in low- and middle-income countries. This systematic review aimed to identify and critically assess full economic evaluations for tobacco control interventions in low- and middle-income countries. METHODS Electronic databases, including EMBASE, MEDLINE and PsycINFO and the grey literature, were searched using terms such as 'tobacco', 'economic evaluation' and 'smoking' from 1994 to 2020. Study quality was assessed using the Consensus Health Economic Criteria and the Philips checklist. Studies were included which were full economic evaluations of tobacco control interventions in low- and middle-income settings. Reviews, commentaries, conference proceedings and abstracts were excluded. Study selection and quality assessment were conducted by two reviewers independently. A narrative synthesis was conducted to synthesize the findings of the studies. RESULTS This review identified 20 studies for inclusion. The studies evaluated a wide range of interventions, including tax increase, nicotine replacement therapy (nicotine patch/gum) and financial incentives. Overall, 12 interventions were reported to be cost-effective, especially tax increases for tobacco consumption and cessation counselling. There were considerable limitations regarding data sources (e.g. using cost data from other countries or assumptions due to the lack of local data) and the model structure; sensitivity analyses were inadequately described in many studies; and there were issues around the transferability of results to other settings. Additionally, the affordability of the interventions was only discussed in two studies. CONCLUSIONS There are few high-quality studies of the cost-effectiveness of tobacco use control interventions in low- and middle-income countries. The methodological limitations of the existing literatures could affect the generalizability of the findings.
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Affiliation(s)
- Xiaobin Jiang
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Muslim Abbas Syed
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tuba Saygın Avşar
- Department of Applied Health Research, University College London, London, UK
| | - Zainab Abdali
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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20
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Colliding Epidemics: Research Gaps and Implementation Science Opportunities for Tobacco Use and HIV/AIDS in Low- and Middle-Income Countries. J Smok Cessat 2022; 2022:6835146. [PMID: 35821759 PMCID: PMC9232349 DOI: 10.1155/2022/6835146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Tobacco use is a leading cause of cancer death among people living with HIV (PLWH) worldwide, and smoking prevalence tends to be higher among PLWH. The burden of both HIV/AIDS and tobacco use is increasingly concentrated in low- and middle-income countries (LMICs), where resources to address these challenges are often limited. However, there has been limited effort to date to integrate tobacco cessation into HIV programs in LMICs. Methods We searched the literature (searching was conducted between October 1 and December 31, 2020) using PubMed including search terms “tobacco” and “HIV” and “cessation” over the past ten years (searching for articles published between December 1, 2010, and December 1, 2020) to identify original research studies on tobacco cessation interventions conducted in LMICs for PLWH. We also conducted an analysis of NCI-funded research grants on tobacco cessation and HIV awarded during fiscal years 2010 to 2020. Results and Discussion. Existing evidence suggests that conventional tobacco cessation treatments may be less effective among PLWH. Moreover, while substantial evidence exists to support a range of cessation interventions, most of this evidence comes from HICs and is only partly applicable to the evolving social, economic, and cultural climate of many LMICs. There is an urgent need to develop, adapt, and implement effective tobacco control and cessation interventions targeted to PLWH in LMICs, as well as to generate evidence from these settings. Implementation science provides tools develop and test strategies to overcome barriers and to integrate and scale up cessation services within existing HIV treatment settings. Conclusion There is a unique opportunity to address HIV and tobacco use in a coordinated way in LMICs by integrating evidence-based tobacco cessation into HIV programs.
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21
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Mortimer K, Reddel HK, Pitrez PM, Bateman ED. Asthma management in low- and middle-income countries: case for change. Eur Respir J 2022; 60:13993003.03179-2021. [PMID: 35210321 PMCID: PMC9474897 DOI: 10.1183/13993003.03179-2021] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Abstract
Asthma is the most common non-communicable disease in children, and among the most common in adults. The great majority of people with asthma live in low- and middle-income countries (LMICs), where they suffer disproportionately high asthma-related morbidity and mortality. Essential inhaled medications, particularly those containing inhaled corticosteroids (ICS), are often unavailable or unaffordable, and this explains much of the global burden of preventable asthma morbidity and mortality.Guidelines developed for LMICs are generally based on the outdated assumption that patients with asthma symptoms <1-3 times/week do not need (or benefit from) ICS. Even when ICS is prescribed, many patients manage their asthma with oral or inhaled short-acting beta2 agonist (SABA) alone, due to issues of availability and affordability. A single ICS-formoterol inhaler-based approach to asthma management for all severities of asthma, from mild to severe, starting at diagnosis, might overcome SABA overuse/over-reliance and reduce the burden of symptoms and severe exacerbations. However, ICS-formoterol inhalers are currently very poorly available or unaffordable in LMICs. There is a pressing need for pragmatic clinical trial evidence of the feasibility and cost-effectiveness of this and other strategies to improve asthma care in these countries.The global health inequality in asthma care that deprives so many children, adolescents and adults of healthy lives and puts them at increased risk of death - despite the availability of highly effective therapeutic approaches - is unacceptable. A World Health Assembly Resolution on universal access to affordable effective asthma care is needed to focus attention and investment on addressing this need.
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Affiliation(s)
- K Mortimer
- Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, United Kingdom (2) Department of Medicine, University of Cambridge, Cambridge, UK
| | - H K Reddel
- The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia
| | - P M Pitrez
- Pediatric Respiratory Division, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - E D Bateman
- Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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22
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Bobrow K, Hoang T, Barnes DE, Gardner RC, Allen IE, Yaffe K. The Effect of Sex and Wealth on Population Attributable Risk Factors for Dementia in South Africa. Front Neurol 2021; 12:766705. [PMID: 34899581 PMCID: PMC8655099 DOI: 10.3389/fneur.2021.766705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: South Africa is a middle-income country with high levels of income inequality and a rapidly aging population and increasing dementia prevalence. Little is known about which risk factors for dementia are important and how they differ by social determinants of health as well as key demographic characteristics such as sex and wealth. We sought to calculate the population attributable risks (PARs) for established potentially modifiable risk factors for dementia among these different groups. Methods: We obtained risk factor prevalence from population-based surveys for established dementia risk factors (diabetes, midlife hypertension, midlife obesity, physical inactivity, depression, smoking, low educational attainment, social isolation). We used relative risk estimates reported in previous meta-analyses and estimated PARs using Levin's formula and accounting for communality. We tested for one-way and two-way interactions by sex and wealth using Pearson's χ2. In stratified analyses, we performed tests for trend using logistic regression. Results: The prevalence of established risk factors for dementia ranged from 5% for depression to 64% for low education. After accounting for communality, the risk factors contributing the greatest PAR were low education (weighted PAR 12%, 95% CI 7% to 18%), physical inactivity (9, 5–14%), and midlife hypertension (6, 5–14%). Together, 45% of dementia cases may be attributable to modifiable risk factors (95% CI 25–59%). We found significant interactions (p < 0.005) between sex, wealth, or both (sex * wealth) and each risk factor except social isolation and physical activity. Low education was inversely associated with wealth in both male and female. The PAR for midlife hypertension, obesity, and diabetes was associated with increasing wealth, and was higher in female. In contrast, the PAR for smoking was higher in male (8% vs. 2%) and was associated with increasing wealth among female only. We found that either a strategy of large reductions in selected risk factors with the highest PAR (midlife hypertension, smoking, physical inactivity) or small reductions across all risk factors could potentially reduce dementia cases by as many as 250,000 by 2050. Discussions: The potential impact on dementia risk by decreasing exposure to established dementia risk factors is large and differs by sex and social determinants of health like wealth. Risk factor PAR should inform national and local health policy dementia initiatives in South Africa including which risk factors to target in the whole population and which to target in high-risk groups for maximum public health benefit.
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Affiliation(s)
- Kirsten Bobrow
- Global Brain Health Initiative at UCSF, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Tina Hoang
- Northern California Institute for Research and Education, San Francisco, San Francisco, CA, United States
| | - Deborah E Barnes
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States.,San Francisco Veterans Affairs Health Care System, San Francisco, San Francisco, CA, United States
| | - Raquel C Gardner
- Global Brain Health Initiative at UCSF, University of California, San Francisco, San Francisco, CA, United States.,San Francisco Veterans Affairs Health Care System, San Francisco, San Francisco, CA, United States.,Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Kristine Yaffe
- Global Brain Health Initiative at UCSF, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States.,Northern California Institute for Research and Education, San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States.,San Francisco Veterans Affairs Health Care System, San Francisco, San Francisco, CA, United States.,Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
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23
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Abstract
OBJECTIVE This study aimed to develop a Transtheoretical-Model-based and WhatsApp-text-message-supported smoking cessation program for pregnant women and to evaluate its effectiveness. METHODS This study is a pretest-posttest designed, randomized controlled and quasi-experimental intervention research. The study was conducted on 50 pregnant women, 25 of them in the intervention group and 25 of them in the control group. A theory-based motivational individual counseling initiative has been applied to the intervention group, and WhatsApp text messages have been sent 3 days a week, in accordance with the stages of change to support the interviews. RESULTS In the final follow-up, 60% of pregnant women in the intervention group and 36% of pregnant women in the control group quit smoking. All participants indicated they would recommend the WhatsApp-text-message-supported smoking cessation program. Transtheoretical-Model-based and WhatsApp-text-message-supported smoking cessation programs were found to be effective in reducing nicotine dependency scores and carbon monoxide levels of pregnant women and quitting smoking. PRACTICE IMPLICATIONS The smoking cessation program used in the research may be applied by midwives or nurses trained on the subject to help pregnant women quit smoking.
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24
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Perez Diaz M, Pochon JB, Ghahremani DG, Dean AC, Faulkner P, Petersen N, Tyndale RF, Donis A, Paez D, Cahuantzi C, Hellemann GS, London ED. Sex Differences in the Association of Cigarette Craving With Insula Structure. Int J Neuropsychopharmacol 2021; 24:624-633. [PMID: 33830218 PMCID: PMC8378076 DOI: 10.1093/ijnp/pyab015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/01/2021] [Accepted: 04/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cigarette craving, which can negatively impact smoking cessation, is reportedly stronger in women than in men when they initiate abstinence from smoking. Identifying approaches to counteract craving in people of different sexes may facilitate the development of personalized treatments for Tobacco Use Disorder, which disproportionately affects women. Because cigarette craving is associated with nicotine dependence and structure of the insula, this study addressed whether a person's sex influences these associations. METHODS The research participants (n = 99, 48 women) reported daily cigarette smoking and provided self-reports of nicotine dependence. After overnight abstinence from smoking, they underwent structural magnetic resonance imaging scanning to determine cortical thickness of the left and right anterior circular insular sulcus, and self-rated their cigarette craving before and after their first cigarette of the day. RESULTS Women reported stronger craving than men irrespective of smoking condition (i.e., pre- and post-smoking) (P = .048), and smoking reduced craving irrespective of sex (P < .001). A 3-way interaction of sex, smoking condition, and right anterior circular insular sulcus thickness on craving (P = .033) reflected a negative association of cortical thickness with pre-smoking craving in women only (P = .012). No effects of cortical thickness in the left anterior circular insular sulcus were detected. Nicotine dependence was positively associated with craving (P < .001) across groups and sessions, with no sex differences in this association. CONCLUSIONS A negative association of right anterior insula thickness with craving in women only suggests that this region may be a relevant therapeutic target for brain-based smoking cessation interventions in women.
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Affiliation(s)
- Maylen Perez Diaz
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Jean-Baptiste Pochon
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Dara G Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Andy C Dean
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Paul Faulkner
- Department of Psychology, University of Roehampton, London, UK
| | - Nicole Petersen
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Rachel F Tyndale
- Department of Pharmacology and Toxicology and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, ON, Canada
| | - Andrea Donis
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Diana Paez
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Citlaly Cahuantzi
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Gerhard S Hellemann
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Edythe D London
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
- Department of Molecular and Medical Pharmacology
- Brain Research Institute, University of California, Los Angeles, California, USA
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25
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EVLİ M, ŞİMŞEK N. Effect of acceptance and commitment-based counseling on smoking cessation and quality of life. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.837634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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26
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Hitsman B. New Individual- and System-Level Intervention Research Aims to Advance Clinical Treatment of Cigarette Smoking and Smokeless Tobacco Use. Nicotine Tob Res 2021; 23:1083-1084. [PMID: 31755914 DOI: 10.1093/ntr/ntz217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Brian Hitsman
- Department of Preventive Medicine and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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27
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Gaudel P, Neupane S, Koivisto AM, Kaunonen M, Rantanen A. Effects of a lifestyle-related risk factor modification intervention on lifestyle changes among patients with coronary artery disease in Nepal. PATIENT EDUCATION AND COUNSELING 2021; 104:1406-1414. [PMID: 33342580 DOI: 10.1016/j.pec.2020.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the effect of a lifestyle-related risk factor modification intervention on coronary artery disease (CAD) patients' lifestyle changes. METHOD A randomized controlled study was conducted in Nepal. A total of 224 CAD patients (112 in each study group) were included at baseline, and 196 patients (98 in each group) completed the one-month follow-up. Patients in the intervention group (IG) received nurse-led intervention in addition to the usual care. Face-to face and telephone interview was conducted using standard questionnaires to collect data on lifestyle-related risk factors; smoking, alcohol consumption, diet, body mass index, stress, adherence to medical therapy, and physical activity. General linear model repeated measure analysis was used to analyse the effects of the intervention. RESULTS Based on self-reported data we found significant improvement in lifestyle-related risk factor habits in the IG compared with the usual care group with respect to diet (p < 0.001), physical activity (p < 0.001), medication adherence (p < 0.001) and stress (p < 0.001) at one-month follow-up. CONCLUSION Lifestyle-related risk factor modification intervention can positively influence health risk habits, even when it is less intensive but supplemented with information leaflets. PRACTICAL IMPLICATIONS Nurse-led one-time intervention may successfully deliver counselling to improve healthy lifestyle among underserved CAD patients.
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Affiliation(s)
- Pramila Gaudel
- Faculty of Social Sciences, Unit of Health Sciences, Nursing Science, Tampere University, Arvo, 33520, Tampere, Finland.
| | - Subas Neupane
- Faculty of Social Sciences, Unit of Health Sciences, Epidemiology, Tampere University, Arvo, 33520, Tampere, Finland.
| | - Anna-Maija Koivisto
- Faculty of Social Sciences, Unit of Health Sciences, Biostatistics, Tampere University, Arvo, 33520, Tampere, Finland.
| | - Marja Kaunonen
- Faculty of Social Sciences, Unit of Health Sciences, Nursing Science, Tampere University, Arvo, and General Administration, Pirkanmaa Hospital District, 33520, Tampere, Finland.
| | - Anja Rantanen
- University Instructor, Faculty of Social Sciences, Unit of Health Sciences, Nursing Science, Tampere University, Arvo, 33520, Tampere, Finland.
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28
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Huang WC, Pham NY, Nguyen TA, Vu VG, Ngo QC, Nguyen VN, Freeman B, Jan S, Negin J, Marks GB, Fox GJ. Smoking behaviour among adult patients presenting to health facilities in four provinces of Vietnam. BMC Public Health 2021; 21:845. [PMID: 33933063 PMCID: PMC8088640 DOI: 10.1186/s12889-021-10880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background Attendance at healthcare facilities provides an opportunity for smoking cessation interventions. However, the smoking behaviours of patients seeking healthcare in Vietnam are not well-understood. We aimed to evaluate behaviours related to smoking among patients presenting to health facilities in Vietnam. Methods We conducted a cross-sectional study in 4 provinces of Vietnam. Consecutive patients aged ≥15 years presenting to 46 health facilities were assessed. Current smokers were randomly selected to complete a full survey about smoking behaviour, quit attempts, and preparedness to quit. Results Among 11,245 patients who sought healthcare, the prevalence of current smoking was 18.6% (95% CI: 17.8–19.4%) overall, 34.6% (95% CI: 33.2–36.0%) among men and 1.1% (95% CI: 0.8–1.3%) among women. Current smokers who were asked about smoking by healthcare providers in the last 12 months were more likely to make quit attempts than those not asked (40.6% vs 31.8%, p = 0.017). Current smokers who attempted to quit in the past 12 months made limited use of cessation aids: counselling (1.9%) and nicotine replacement therapy (10%). A higher proportion of patients wanted to quit in the next month at national/provincial hospitals (30.3%) than those visiting district hospitals (11.3%, p < 0.001) and commune health centres (11.1%, p = 0.004). Conclusions Smoking is common among male patients presenting to healthcare facilities in Vietnam. Formal smoking cessation supports are generally not used or offered. This population is likely to benefit from routine smoking cessation interventions that are integrated within the routine healthcare delivery system. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10880-z.
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Affiliation(s)
- Wan-Chun Huang
- Woolcock Institute of Medical Research, Hanoi, Vietnam. .,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia. .,Division of Thoracic Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Ngoc Yen Pham
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | | | - Van Giap Vu
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Quy Chau Ngo
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Becky Freeman
- School of Public Health, University of Sydney, Sydney, Australia
| | - Stephen Jan
- Health Economics and Process Evaluation Program, George Institute for Global Health, Sydney, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Gregory J Fox
- Woolcock Institute of Medical Research, Hanoi, Vietnam.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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29
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Hejjaji V, Khetan A, Hughes JW, Gupta P, Jones PG, Ahmed A, Mohan SKM, Josephson RA. A combined community health worker and text messagingbased intervention for smoking cessation in India: Project MUKTI - A mixed methods study. Tob Prev Cessat 2021; 7:23. [PMID: 33791445 PMCID: PMC8005919 DOI: 10.18332/tpc/132469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/26/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We sought to evaluate the effectiveness of a community health worker (CHW) led smoking cessation intervention, supplemented by text messages, and tailored to an individual’s readiness to quit. METHODS We conducted a cluster randomized controlled trial (April 2018–August 2019) in adult smokers residing in a semi-urban region of India. Participants in the intervention arm received CHW-led home visits and had the option of choosing to receive regular text messages. The dose and content of CHW counseling and text messages were tailored to the participant’s readiness to quit. The control group received brief education only. Primary outcome was biochemically verified smoking cessation at the end of 12 months. Both intention-to-treat and as-treated analyses were performed. RESULTS A total of 238 (mean age 43±12.3 years, male 96.2%) participants were enrolled; 151 (64%) in the intervention arm and 83 (35.4%) in the control arm. At 12 months, 31 (20.5%) participants in the intervention arm and 9 (10.8%) in the control arm quit smoking (absolute risk difference=9.7%; RR=1.69; 95% CI: 0.04–71.33, p=0.74). In the as-treated analysis, 17 (36.9%) of the 46 participants who received optimal dose of the intervention quit smoking. CONCLUSIONS CHW-led home-based counseling, supplemented by regular text messages, led to an increase in quit rates for smoking, especially among those exposed to a higher dose of the intervention. However, the difference in cessation rates was not statistically significant. Future studies should consider testing mobile application-based multimedia messaging with larger populations, as a supplement to CHW-based counseling.
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Affiliation(s)
- Vittal Hejjaji
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas, United States
| | - Aditya Khetan
- Department of Cardiovascular Medicine, McMaster University Medical Center, Hamilton, Canada
| | - Joel W Hughes
- Department of Psychology, Kent State University, Kent, United States
| | - Prashant Gupta
- Department of Psychology, All India Institute of Medical Sciences, New Delhi, India
| | - Philip G Jones
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas, United States
| | - Asma Ahmed
- Department of Surgery, Ramaiah Medical College, Bangalore, India
| | - Sri Krishna Madan Mohan
- Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center - Case Western Reserve University, Cleveland, United States
| | - Richard A Josephson
- Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center - Case Western Reserve University, Cleveland, United States
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30
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Kumar N, Janmohamed K, Jiang J, Ainooson J, Billings A, Chen GQ, Chumo F, Cueto L, Niaura R, Zhang A. Tobacco cessation in low- to middle-income countries: A scoping review of randomized controlled trials. Addict Behav 2021; 112:106612. [PMID: 33002679 DOI: 10.1016/j.addbeh.2020.106612] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/24/2020] [Accepted: 08/15/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The growing prevalence of tobacco use in low "to middle" income countries (LMICs) and the hurdles of conducting tobacco cessation in that context necessitates a focus on the scope of randomized controlled trials (RCTs) in LMICs to guide tobacco cessation in this environment. We conducted a scoping review to identify LMIC tobacco cessation RCTs. METHODS Consistent with PRISMA-ScR guidelines and without language restrictions, we systematically searched peer-reviewed databases (MEDLINE, Embase, PsycINFO, articles published since inception, latest searches in March 2020) and gray literature (clinical trials registries, searches between September and December 2019). We searched for data on RCT type, outcome significance and intervention description. Inclusion: research conducted in LMICs; tobacco cessation; RCT. Exclusion: research conducted in high income countries; non-RCT; studies involving only those aged <18. Data was extracted from published reports. We generated narrative summaries of each LMIC's tobacco cessation RCT research environment. RESULTS Of 8404 articles screened, we identified 92 studies. Tobacco cessation RCTs were recorded in 16 of 138 countries/territories in LMICs. Evidence was weak in quality and severely limited. Most RCTs were psychosocial, with limited behavioral and pharmacological variants. CONCLUSIONS Tobacco control within LMICs is essential to reduce the tobacco mortality burden. Researchers should be cognizant that tobacco cessation in LMICs is still not an environment where best practice has been established. We suggest that developing solutions specific for LMICs is key to effective tobacco control in LMICs.
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Weng X, Luk TT, Suen YN, Wu Y, Li HCW, Cheung YTD, Kwong ACS, Lai VWY, Chan SSC, Lam TH, Wang MP. Effects of simple active referrals of different intensities on smoking abstinence and smoking cessation services attendance: a cluster-randomized clinical trial. Addiction 2020; 115:1902-1912. [PMID: 32149425 DOI: 10.1111/add.15029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/06/2020] [Accepted: 02/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Proactive brief cessation advice by a lay counsellor combined with a referral to a smoking cessation service (active referral) is effective in increasing service use and quitting in community smokers. We compared the effect of two modified approaches to referrals on the cessation outcomes in community smokers. DESIGN Three-arm cluster-randomized trial. SETTING General community in Hong Kong. PARTICIPANTS Daily cigarette smokers (n = 1163; 77.7% male). INTERVENTIONS Participants were randomized to receive on-site active referral (OSR, n = 395), where lay counsellors helped participants make appointments with a smoking cessation service of their choice plus tailored reminders; mobile text messaging referral (TMR, n = 385), where participants were encouraged to use a smoking cessation service via text messages; or brief cessation advice only (control, n = 383). MEASUREMENTS The primary outcome was a self-reported 7-day point-prevalence abstinence at 6 months post-treatment initiation. Secondary outcomes included 7-day point-prevalence abstinence at 3 and 18 months, biochemically validated abstinence, smoking reduction and the use of cessation services at 3, 6 and 18 months. FINDINGS Using intention-to-treat analysis, the OSR (17.7%) and TMR (17.1%) groups had significantly higher self-reported abstinence than the control (12.0%) group at 6 months [odds ratio (OR) for OSR versus control = 1.58, 95% confidence interval (CI) = 1.06-2.36; OR for TMR versus control = 1.52, 95% CI = 1.01-2.28; both P < 0.05]. The corresponding validated abstinence rates at 6 months were 7.6, 7.8 and 3.9% (OR for TMR versus control = 2.02, 95% CI = 1.07-3.81; OR for TMR versus control = 2.07, 95% CI = 1.10-3.92; both P < 0.05). Self-reported and validated abstinence were similar at 18 months. OSR groups had higher rates of smoking cessation service use than the control group at all follow-ups (all P < 0.001). The smoking reduction rates were similar in continuing smokers. CONCLUSIONS Simple active referrals (in person or via text messaging) to smoking cessation services increased abstinence rates among smokers in Hong Kong compared with general brief cessation advice. On-site active referral increased the use of smoking cessation services compared with general brief cessation advice.
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Affiliation(s)
- Xue Weng
- School of Nursing, the University of Hong Kong, Pokfulam, Hong Kong
| | - Tzu Tsun Luk
- School of Nursing, the University of Hong Kong, Pokfulam, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, the University of Hong Kong, Pokfulam, Hong Kong
| | - Yongda Wu
- School of Nursing, the University of Hong Kong, Pokfulam, Hong Kong
| | | | | | | | | | | | - Tai-Hing Lam
- School of Public Health, the University of Hong Kong, Pokfulam, Hong Kong
| | - Man Ping Wang
- School of Nursing, the University of Hong Kong, Pokfulam, Hong Kong
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Specific Relapse Predictors: Could Cognitive-Behavioral Treatment for Smoking Cessation Be Improved? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124317. [PMID: 32560325 PMCID: PMC7344644 DOI: 10.3390/ijerph17124317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/23/2022]
Abstract
Relapse remains a frequent and complex phenomenon that is not yet well understood. An under-researched area of study that may provide relevant information concerns the assessment of specific post-treatment variables, rather than the composite measures commonly used to predict smoking relapse. The current study sought to examine the effects of post-treatment smoking-related variables, including withdrawal symptomatology, abstinence self-efficacy, and smoking urgency in negative-affect situations and smoking relapse at the 3 month follow-up. The sample comprised 130 participants who achieved abstinence for at least 24 h through a cognitive-behavioral smoking cessation treatment. Regression analysis was conducted for both composite measures and specific subscales and items. Data showed that composite measures of tobacco withdrawal, self-efficacy, and smoking urgency in negative-affect situations were not significant predictors of smoking relapse. However, the analysis including subscales, and specific items showed that lower self-efficacy in negative-affect-related situations (OR = 1.36) and three withdrawal symptoms—irritability/frustration/anger (OR = 2.99), restlessness/impatience (OR = 1.87), and craving (OR = 2.31)—were significant predictors of relapse. These findings offer new insights into the role of different smoking-related post-treatment variables in short-term relapse. Considering and specifically targeting these variables after achieving abstinence may potentially contribute to reducing smoking relapse.
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Kienen N, Wiltenburg TD, Bittencourt L, Scarinci IC. Development of a gender-relevant tobacco cessation intervention for women in Brazil-an intervention mapping approach to planning. HEALTH EDUCATION RESEARCH 2019; 34:505-520. [PMID: 31495883 PMCID: PMC7962721 DOI: 10.1093/her/cyz025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this article is to describe the development of a theory-based, culturally and gender-relevant Community Health Worker (CWH)-led tobacco cessation intervention for low-income Brazilian women who augments the tobacco cessation program offered through the public health system using Intervention Mapping (IM). We began with the establishment of a network of representatives from different segments of society followed by comprehensive needs assessments. We then established a logical planning process that was guided by a theoretical framework (Social Cognitive Theory) and existing evidence-based tobacco cessation programs, taking into account socio-political context of a universal health care system. Given the gender-relevance of our intervention and the importance of social support in tobacco cessation among women, we chose an intervention that would be delivered within the public health system but augmented by CHWs that would be trained in behavior change by researchers. One of major advantages of utilizing IM was that decisions were made in a transparent and supportive manner with involvement of all stakeholders throughout the process. Despite the fact that this process is very taxing on researchers and the health care system as it takes time, resources and negotiation skills, it builds trust and promotes ownership which can assure sustainability.
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Affiliation(s)
- Nádia Kienen
- Department of Psychology and Behavior Analysis, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid, PR 445 Km 380, Londrina, PR, Brazil
| | - Thaís Distéfano Wiltenburg
- Department of Psychology and Behavior Analysis, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid, PR 445 Km 380, Londrina, PR, Brazil
| | - Lorna Bittencourt
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, MT 609, Birmingham, AL, USA
| | - Isabel C Scarinci
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, MT 609, Birmingham, AL, USA
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Akanbi MO, Carroll AJ, Achenbach C, O'Dwyer LC, Jordan N, Hitsman B, Bilaver LA, McHugh MC, Murphy R. The efficacy of smoking cessation interventions in low- and middle-income countries: a systematic review and meta-analysis. Addiction 2019; 114:620-635. [PMID: 30506845 PMCID: PMC6411424 DOI: 10.1111/add.14518] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/27/2018] [Accepted: 11/23/2018] [Indexed: 12/28/2022]
Abstract
AIMS To summarize evidence for the efficacy of smoking cessation interventions in low- and middle-income countries (LMICs). DESIGN Systematic review and meta-analysis of randomized controlled trials. SETTING LMICs as defined by the World Bank. PARTICIPANTS Adult current cigarette smokers residing in LMICs. INTERVENTIONS Behavioral and/or pharmacotherapy smoking cessation interventions. MEASUREMENTS PubMed MEDLINE, EMBASE (embase.com), Cochrane Central Register of Controlled Trials (Wiley), PsycINFO (Ebsco), SciELO, WHO Global Index Medicus and Scopus were searched from inception to 4 April 2018. Only studies with at least 6 months of follow-up were included. We used the most rigorous assessment of abstinence reported by each study. Effect sizes were computed from abstracted data. Where possible, a meta-analysis was performed using Mantel-Haenzel random-effect models reporting odds ratios (OR) and 95% confidence intervals (CI). FINDINGS Twenty-four randomized controlled trials were included. Six investigated the efficacy of pharmacological agents. Four trials that compared nicotine replacement therapy (NRT) to placebo found NRT improved cessation rates (n : NRT 546, control 684, OR = 1.76, 95% CI = 1.30-2.77, P < 0.001, I2 = 13%). Eight trials found that behavioral counseling was more effective than minimal interventions (e.g. brief advice); n : Counseling 2941, control 2794, OR = 6.87, 95% CI = 4.18-11.29, P < 0.001, I2 = 67%). There was also evidence of the benefit of brief advice over usual care (n : Brief advice 373, control 355, OR = 2.46, 95% CI = 1.56-3.88, P < 0.001, I2 = 0%). CONCLUSION Nicotine replacement therapy, behavioral counseling and brief advice appear to be effective in aiding smoking cessation in low- and middle-income countries. There is limited rigorous research on other smoking cessation interventions in these regions.
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Affiliation(s)
- Maxwell Oluwole Akanbi
- Health Sciences Integrated PhD Program, Center for Education in Health SciencesInstitute for Public Health and Medicine, Northwestern University Feinberg School of MedicineChicagoILUSA,Center for Global HealthNorthwestern UniversityChicagoILUSA
| | - Allison Jane Carroll
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Chad Achenbach
- Center for Global HealthNorthwestern UniversityChicagoILUSA,Department of Infectious DiseasesNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Linda Catherine O'Dwyer
- Galter Health Sciences Library and Learning CenterNorthwestern University, Feinberg School of MedicineChicagoILUSA
| | - Neil Jordan
- Health Sciences Integrated PhD Program, Center for Education in Health SciencesInstitute for Public Health and Medicine, Northwestern University Feinberg School of MedicineChicagoILUSA,Hines VA HospitalHinesILUSA
| | - Brian Hitsman
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Lucy Ann Bilaver
- Health Sciences Integrated PhD Program, Center for Education in Health SciencesInstitute for Public Health and Medicine, Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Megan Colleen McHugh
- Health Sciences Integrated PhD Program, Center for Education in Health SciencesInstitute for Public Health and Medicine, Northwestern University Feinberg School of MedicineChicagoILUSA
| | - Robert Murphy
- Center for Global HealthNorthwestern UniversityChicagoILUSA,Department of Infectious DiseasesNorthwestern University Feinberg School of MedicineChicagoILUSA
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Mechili EA, Girvalaki C, Saliaj A, Filippidis FT, Vardavas CI. WHO FCTC Article 14 enforcement in Albania: An urgent issue to tackle. Tob Prev Cessat 2019; 5:6. [PMID: 32411871 PMCID: PMC7205049 DOI: 10.18332/tpc/103126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/18/2018] [Accepted: 01/23/2019] [Indexed: 11/27/2022]
Abstract
Tobacco use is a major preventable risk factor for non-communicable diseases such as cardiovascular disease, cancer etc. Smoking prevalence in Albania is high. The country ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in 2006 and has passed different bills and adopted strict tobacco control laws during the years. Despite this, there is a huge gap in primary healthcare (PHC) personnel education in this field. Additionally, tobacco treatment support facilities, such as free of charge telephone quit lines, tobacco treatment clinics in hospitals or in the community, are lacking or not well established. Training of healthcare professionals in evidence-based practices as well as the development of national guidelines on tobacco treatment, capacity building for tobacco treatment delivery, pharmacotherapy availability, public opinion awareness and promotion of smoking cessation practices are some of the measures Albanian policy makers should undertake.
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Affiliation(s)
- Enkeleint A Mechili
- Department of Healthcare, Faculty of Public Health, University of Vlora, Vlora, Albania
| | | | - Aurela Saliaj
- Department of Healthcare, Faculty of Public Health, University of Vlora, Vlora, Albania
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, United Kingdom
| | - Constantine I Vardavas
- Medical School, University of Crete, Heraklion, Greece.,Institute of Public Health, American College of Greece, Athens, Greece
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